Treatment of clinically localized prostate cancer

Purpose of our study is to carry out: comparative analysis of results of radical prostatectomy and conformal radiotherapy in patients with clinically localized prostate cancer.

Materials and methods. For retrospective analysis we chose data from 177 patients with stage сT1—2N0M0 prostate cancer treated in the N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences from 1997 to 2007. Median age of patients was 61,3 years and ranged from 38 to 76 years. Before treatment median level of serum prostate specific antigen was 15,5±15,1 ng/ml and median Gleason index — 2,6±0,7 + 3,2±0,6 = 5,7±1,1. Retropubic radical prostatectomy was performed in 133 (75,4%) patients and external conformal radiotherapy — in 44 (24,6%) patients. Study groups were matched according to main parameters. Median follow-up time was 26,2±30,2 months.

Results. Prostate gland capsule invasion was found in у 43 (32,3%), perineural growth — in 56 (31,3%), invasion of seminal vesicles — in 12 (6,8%), angiolymphatic invasion — in 53 (29,9%), positive surgical margins — in 9 (5,1%), pN+ — in 7 (4,0%) from 133 operated patients. In all 44 cases compete responses to radiotherapy were registered. Among 177 patients 5-year survival was 95,0%, specific survival — 100%, and survival without PSA relapse — 76,8%. According to monofactorial and multifactorial analyses favorable prognostic factors for survival without PSA relapse are radical prostatectomy (р=0,003 and р=0,019 respectively) and Gleason index <7 (p=0,012 and p=0,045 respectively). Advantage of operated patients over the patients treated with radiotherapy in regard to survival without PSA relapse rates is statistically significant in cases with Gleason indices <7 (р=0,013) and initial level of serum prostate specific antigen <10 ng/ml (р=0,005).

Conclusion. Both surgical treatment and radiotherapy allows reaching favorable results in patients with stage cT1—2N0M0 prostate cancer. It is obvious that when choosing the preferred treatment modality the Gleason index and level of prostate specific antigen should be taken into account. Probably, repeat analysis after longer follow up time will allow drawing more definite conclusions about advantages of surgery and radiotherapy in the treatment of patients with stage cT1—2N0M0 prostate cancer of different prognostic groups.