A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months.
BACKGROUND
To investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy.


METHODS
One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissection and 49 were treated with external beam radiation by linear accelerator with 40-50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined.


RESULTS
Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2% versus 71.1% for biochemical progression-free rates; P=0.25, 83.5% versus 66.1% for clinical progression-free rates; P=0.14, 85.7% versus 77.1% for cause-specific survival rates; P=0.06, and 67.9% versus 60.9% for overall survival rates; P=0.30), although none of them reached statistical significance. Erectile dysfunction was recognized in almost all patients as a result of continuous endocrine therapy. Incontinence requiring more than one pad per day was observed more frequently in the surgery group than the radiation group (P<0.01).


CONCLUSIONS
For the treatment of patients with locally advanced prostate cancer, when combined with endocrine therapy, either radical prostatectomy or external beam radiotherapy demonstrated favorable long-term outcomes. The radiation dose of 60-70 Gy might not be enough for the local treatment of locally advanced prostate cancer.
Akakura
Koichiro
K
Department of Urology, Chiba University, Japan. akakurak@tkn-hosp.gr.jp
Suzuki
Hiroyoshi
H
Ichikawa
Tomohiko
T
Fujimoto
Hiroyuki
H
Maeda
Osamu
O
Usami
Michiyuki
M
Hirano
Daisaku
D
Takimoto
Yukie
Y
Kamoto
Toshiyuki
T
Ogawa
Osamu
O
Sumiyoshi
Yoshiteru
Y
Shimazaki
Jun
J
Kakizoe
Tadao
T
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D011795:Surveys and Questionnaires; D013997:Time Factors
D000726:Androgen Antagonists