Adjuvant Radiotherapy Following Radical Prostatectomy: Results and Complications

Abstract

Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year followup. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not. The groups were comparable with regard to significant prognostic variables. Patient selection was by surgeon preference. Local recurrences were seen in 1 of 22 patients (5 per cent) receiving adjuvant radiotherapy and 7 of 23 (30 per cent) undergoing an operation alone (p less than 0.05). Of 8 patients with local recurrence 7 died of the disease. Delayed radiotherapy of a local recurrence generally was not effective in controlling the disease. Of the 11 patients who died of prostatic cancer with a mean followup of 9.2 years 3 received adjuvant radiotherapy and 8 did not. Severe but nonfatal long-term complications were seen in 14 per cent of the irradiated patients and 6 per cent of those treated with an operation alone. Most of the complications occurred in the earlier years of the study in patients who received 60cobalt radiotherapy. When clinical stage B cancer of the prostate is found to be pathological stage C following radical perineal prostatectomy, adjuvant radiotherapy can decrease the incidence of subsequent local recurrence. The potential risk of adjuvant radiation therapy should be weighed and its use considered, particularly in patients whose tumor extends to the surgical margins or who have seminal vesicle invasion.

Predictive Value of Pathological Features for Progression after Radical Prostatectomy

“…The few patients whose surgical margins are negative but progress (without positive seminal vesicle) are likely pathologic sampling errors as showed by Humphrey et al [14], Capsular effraction increases the rates of positive sur gical margins and biological progression. If there is an extraglandular involvement, 52% [16] to 60% [14] of the patients have positive margins (69% in our series). In this study, 80% of the patients with extracapsular disease pro gress because of positive margins or unsuspected micro metastasis, but further follow-up will be necessary to establish the length of the disease-free interval after radi cal prostatectomy in patients with capsular effraction.…”

Adjuvant and Salvage Radiotherapy After Prostatectomy for Prostate Cancer: A Literature Review

“…Certain clinical trials of postoperative RT included patients with measurable prostate-specific antigen (PSA) levels; therefore, the term ''immediate postoperative RT'' should be preferred to ''adjuvant RT.'' Although immediate postoperative RT has been used to reduce the risk of recurrence for several years now, only a few retrospective series or case reports were found (2)(3)(4)(5)(6)(7)(8). However, in 2005 and 2006, two large, randomized, controlled studies (9,10) were published in full and a third (11) was published in abstract form; hence, retrospective series on this topic have not been discussed.…”

Management of the complications of radical prostatectomy

“…Patients with elevated postoperative PSA levels, pelvic lymph node metastasis, seminal vesicle invasion, extracapsular tumor extension, high-grade tumor, or positive surgical margins can benefit from XRT [43,46]. Gibbons et al [47] reported a lower 5-year recurrence rate in patients with margin-positive disease who received XRT versus no therapy. Unfortunately there was no statistical analysis in this report.…”