Twenty years follow-up of patients with inoperable cancer of the prostate (stage c) treated by radiotherapy: Report of a national cooperative study

Purpose : To evaluate the longevity and curability of patients with inoperable, Stage C, carcinomas of the prostate by means of external pelvic irradiation. Methods and Materials : 372 patients, averaging 61 years of age, with histologically proven adenocarcinoma of the prostate, Stage C, received radiotherapy as part of a National Research Study, from 1967 to 1973. Treatments were administered in accordance with a strict protocol. Portals of entry were optional but it was required that the total dose received at the center of the prostate should be no less than 7000 cGy in no less than 47 days or 7500 cGy in 54 days. Results : 245 of the 372 patients survived 5 years without evidence of recurrence or metastases; 142 were living after l0.years, 64 after 15 years, and 24 after 20 years. A total of 167 patients (44%) survived for years and died from intercurrent diseases without evidence of prostatic cancer. A total of 177 patients (47%) died of prostatic cancer in decreasing proportions in the years after treatment. Mild episodes of hematuria and of rectal bleeding were recorded in a number of patients; urethral and rectal strictured occurred following cystitis and proctitis but no life-threatening complications occurred. Conclusions : Adequately fractionated external pelvic irradiation can eradicate inoperable intrapelvic prostatic cancer. A simple statement of survival would disregard the fact that these elderly patients may be cured of cancer and yet may die of intercurrent diseases proper of their age. Also, it may be expected that a number of patients with Stage C may have unsuspected subclinical bone metastases when first seen and that death from metastases is not necessarily a reflection on the effectiveness of the regional treatment.