Observations on surgical management of carcinoma of prostate with limited nodal metastases.
One hundred patients with surgical Stage D1 (TXN + M0) adenocarcinoma of the prostate underwent pelvic lymphadenectomy and radical retropubic prostatectomy and were followed up for one-half to fifteen and one-half years. Forty-eight patients received "adjuvant" hormonal or radiation (or both) treatment; all patients were treated ("delayed") hormonally on disease progression, when this treatment had not been administered initially. Tumor grade (Mayo 1 through 4), tumor bulk (measured in cm3), or seminal vesicle involvement alone and when considered with number of positive nodes was not related to survival or disease progression. Only number of positive nodes and bilateral orchiectomy as "adjuvant" treatment affected survival and progression. For the 52 patients without "adjuvant" orchiectomy, the overall five-year rate for nonprogression was only 18.5 per cent, and the five-year rates for nonprogression were, respectively, 26, 0, and 0 per cent when 1, 2, and greater than or equal to 3 positive nodes were considered. However, for the 37 patients who received "adjuvant" orchiectomy, the overall five-year rate for nonprogression was 95 per cent, and the five-year rates for nonprogression were, respectively, 100, 100, and 80 per cent when 1, 2, and greater than or equal to 3 positive nodes were considered. Prostatic cancer with positive pelvic lymph nodes treated by pelvic lymphadenectomy and radical retropubic prostatectomy alone leads to rapid disease progression. "Adjuvant" bilateral orchiectomy is associated with projected five- and ten-year survival rates of 94 per cent and 80 per cent, respectively. Recommendation of other treatment modalities for patients with Stage D1 cancer of the prostate should be considered with reference to the results presented herein.
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D002369:Castration; D003131:Combined Modality Therapy; D004054:Diethylstilbestrol / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D013997:Time Factors
D004054:Diethylstilbestrol