Radiotherapy for prostatic cancer: patient selection and the impact of local control

Objective. To analyze the long-term results of external beam radiation therapy in patients under the age of sixty treated with early-stage prostate cancer. A comparison is also made between patients with early-stage, node-negative disease and those with locally advanced node-negative prostate cancer. Methods. In this retrospective study, 54 patients who were treated with external beam radiation, when under the age of sixty with Stanford stage T1 a and T1 b (equivalent to urologic stage B 1), are compared to 75 patients with similar staged disease who were sixty to seventy years old at time of treatment. In addition, 17 men who underwent open lymph node dissection with Stanford stage T1 a and T1 b NOW (equivalent to urologic stage B 1, pathologic node negative) were compared to 30 patients with Stanford stage T3NOMO (equivalent to urologic stage C, pathologic node negative) prostatic carcinoma. Results. Patients under the age of sixty with clinically staged early prostate cancer exhibited a similar rate of local and metastatic control when compared to men treated when sixty to seventy years of age. Overall survival was not different than the expected survival in both groups. In patients with laparotomy-proven node-negative prostate cancer, those with locally advanced tumors had a poorer rate of local control, disease-specific survival, freedom from relapse, and survival when compared to patients with early-stage disease. Conclusions. These results suggest that men under sixty years old are candidates for radiotherapy, and these results are comparable to those attained with prostatectomy. Treatment approaches for controlling bulky local disease in patients without lymph node metastases have a potential to improve local control that may have an impact on survival.