Carcinoma of the prostate: a model for management under impending health care system reform. 1994 RSNA annual oration in radiation oncology.
OBJECTIVE
To review past and possible future management of localized carcinoma of the prostate.


METHODS
Cases were reviewed of 963 patients with localized carcinoma of the prostate treated with external irradiation between 1967 and 1992.


RESULTS
In 287 patients who underwent pretreatment pedal lymphangiography, there was a positive but not statistically significant correlation between normal or abnormal findings and 10-year disease-free survival (DFS) with clinical stage A (T1a-T1c), B (T2), or C (T3) disease. In 483 patients who underwent pretreatment computed tomography (CT) of the pelvis and abdomen, there was no correlation between radiologic findings and outcome for stage A2 and B disease. With stage C disease and no evidence of positive pelvic lymph nodes, 10-year DFS was 50%. No patients with positive lymph nodes survived. With stage C disease and periprostatic or seminal vesicle involvement, 10-year DFS was 19%, and it was 42% without those findings (P < or = .01).


CONCLUSIONS
Prospective clinical trials must be performed to help define optimal management of prostatic cancer.
Perez
C A
CA
Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63108, USA.
D000230:Adenocarcinoma / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D003363:Cost Control; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D018166:Health Care Reform; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed