title: Outcome of patients with localized prostate cancer treated by radiotherapy after confirming the absence of lymph node invasion.
abstract: OBJECTIVE
  Management of lymph nodes in radiotherapy for prostate cancer is an issue for curative intent. To find the influence of lymph nodes, patients with T1-T3 prostate cancer and surgically confirmed negative nodes were treated with radiotherapy.
  
  
  METHODS
  After lymphadenectomy, 118 patients received photon beam radiotherapy with 66 Gy to the prostate. No adjuvant treatment was performed until biochemical failure. After failure, hormone therapy was administered. Follow-up period was 57 months (mean).
  
  
  RESULTS
  Biochemical failure occurred in 47 patients. Few failures were observed in patients with low (24%) and intermediate risks (14%). In contrast, 64% of high-risk patients experienced failure, 97% of whom showed until 36 months. Most patients with failure responded well to hormone therapy. After 15 months (mean), a second biochemical failure occurred in 21% of patients who had the first failure, most of them were high risk. Factors involving failure were high initial and nadir prostate-specific antigen, advanced stage, short prostate-specific antigen-doubling time and duration between radiation and first failure. Failure showed an insufficient reduction in prostate-specific antigen after radiotherapy. Factor for second failure was prostate-specific antigen-doubling time at first failure.
  
  
  CONCLUSIONS
  Half of high-risk patients experienced biochemical failure, indicating one of the causes involves factors other than lymph nodes. Low-, intermediate- and the other half of high-risk patients did not need to take immediate hormone therapy after radiotherapy. After failure, delayed hormone therapy was effective. Prostate-specific antigen parameters were predictive factors for further outcome.
authors.affiliation: Department of Urology, Asahi General Hospital, Asahi, Chiba, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Masaki
authors.initials: M
authors.lastname: Shimbo
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Amiya
authors.forename: Susumu
authors.initials: S
authors.lastname: Tomioka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shima
authors.forename: Shino
authors.initials: S
authors.lastname: Murakami
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Nakatsu
authors.forename: Sayako
authors.initials: S
authors.lastname: Oota
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome
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