Rate of relapse following treatment for localized prostate cancer: a critical analysis of retrospective reports.
OBJECTIVE
Controversy exists over the optimal treatment for patients with clinically localized prostate cancer. Almost all of the treatment results are from non-randomized trials and interseries comparison is difficult since the apparent success of a treatment, as judged by the actuarial freedom from relapse and survival data, depends on patient selection criteria and post-treatment evaluation, in addition to the efficacy of the therapeutic intervention. In this report the calculation of a hazard function is used to estimate and compare the rate of relapse for the different treatments.


METHODS
Clinical reports from major surgery and radiation oncology treatment institutions were analyzed. The actuarial recurrence data were used to calculate the annual rate of recurrence within each series.


RESULTS
For all but the lowest volume tumors, patients continue to be at risk of relapse for as long as these series have been followed. Despite the heterogeneity of patient populations, the recurrence rates by stage are similar for patients treated with surgery or irradiation. This result is consistent with pathologic data from prostatectomy specimens which indicate that for lesions > 12 cm3 (approx. 3 cm in diameter) there is high likelihood of extraprostatic disease.


CONCLUSIONS
Treatment outcome for patients with localized prostate cancer may be more dependent on the inherent tumor biology than the particular type of treatment. Accordingly, the expectation and recommendation of a treatment must take into consideration the continued risk of relapse with either radiation therapy or surgery. There are, as yet, insufficient data regarding the impact of screening and earlier diagnosis on the curability of patients with localized prostate cancer.
Coleman
C N
CN
Joint Center for Radiation Therapy, Boston, MA 02115.
Beard
C J
CJ
Kantoff
P W
PW
Gelman
R
R
D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies