Definitive radiotherapy of prostate cancer: the possible role of staging lymphadenectomy

To evaluate the postradiotherapy 5-year cancer-specific (CSS), clinical progression-free (cPFS), and overall (OS) survival rates in patients with pN0 M0 prostate cancer (PC). Between 1989 and 1996, 203 consecutive pN0 M0 PC patients (T1–2, 66; T3–4, 137) received conformal prostatic four-field radiotherapy (median target dose 66 Gy). Any hormone manipulation was delayed until clinical progression (growth of the primary tumor or development of distant metastases). After a median observation time of 87 months (range 11–156), 99 patients had relapsed clinically and 70 patients were dead, 37 of them as a result of prostate cancer. Five-year CSS, cPFS, and OS rates were, respectively, 90% (95% CI 86–94%), 64% (95% CI 57–71%), and 82% (95% CI 77–87%), with no difference of OS compared with age-matched males from the general population. Gleason score (≤7A vs. ≥7B) and the T category predicted cPFS, whereas CSS was associated with Gleason score only. Preradiotherapy PSA failed to predict survival. Patients with T1–2 Gleason score ≤7A had a 97% 5-year CCS, as compared with 89% for all other patients. A median of eight lymph nodes (range 0–29) were described in the specimens from pelvic lymphadenectomy (LA). Despite still preliminary observations, our 5-year results challenge the use of combined hormone radiotherapy in patients who are proven to be pN0 by preradiotherapy LA; in particular, in patients with T1–2/Gleason score ≤7A, whereas the survival in all other patients with pN0 M0 prostate cancer may be improved by adjuvant androgen deprivation.