title: Radical prostatectomy and postoperative radiation in patients with adenocarcinoma of prostate of intermediate and high risk for recurrence.
abstract: OBJECTIVE
  To report on the outcome of patients with intermediate and high risk of recurrence who underwent radical prostatectomy (RP).
  
  
  METHODS
  Eighty-five consecutive patients categorized as intermediate (17.5%) and high risk (82.5%) of failure after definitive therapy for carcinoma of prostate according to the National Comprehensive Cancer Network (NCCN) underwent RP between 1989 and 1997. Median preoperative PSA was 26 ng/ml (range 15 ng/ml-91 ng/ml). Fifty-nine patients (70%) received three months neoadjuvant hormone therapy. Thirty-six patients (42%) underwent early (three to four months after RP) adjuvant radiation for pT3 disease and/or positive surgical margins.
  
  
  RESULTS
  The median follow-up was 58 months (range 12-104 months). There was no difference in the biochemical recurrence rate between the intermediate and high-risk group of patients. The overall relapse rate was 33%. Cancer-specific mortality was 3.5%. Patients with T1c tumors had a significantly lower biochemical recurrence rate (bRR) (7%) compared to palpable tumors (p = 0.03). Age above 65 was a significant negative prognostic factor with respect to biochemical recurrence (p = 0.01). Adjuvant radiation was associated with biochemical recurrence rates of 25% vs. 40% in patients who were not radiated (p = 0.05).
  
  
  CONCLUSIONS
  In the intermediate and high-risk groups of patients with nonpalpable prostate cancer, RP and adjuvant RT may provide a biochemical recurrence-free rate (bRFR) comparable to that reported in other series with RP alone on patients in the low-risk groups. We encourage the multimodality treatment approach incorporating adjuvant postoperative radiation in these patients.
authors.affiliation: Department of Urology, UAMS, Little Rock, Arkansas, USA.
authors.forename: Endre Z
authors.initials: EZ
authors.lastname: Neulander
authors.forename: Zev
authors.initials: Z
authors.lastname: Wajsman
authors.forename: Graham F
authors.initials: GF
authors.lastname: Greene
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome