[Recurrent prostatic carcinoma after curative radiotherapy and radical prostatectomy]

The authors evaluate indication criteria for individual therapeutic modalities of localized and locally advanced prostate cancer (CaP), but especially investigate progression of the disease in relation to CaP classification and other prognostic criteria.

The paper evaluates 120 patients altogether, treated by curative radiotherapy (RT) and 115 patients who underwent radical retropubic prostatectomy (RAPE). The patients were followed according to age, PSA value, Gleason score and life prognosis. The Partin nomograms were used to evaluate probability of localized disease, locally advanced disease, the involvement of seminal vesicles (gonecysts) and lymphatic nodes. The patients were also stratified according to T-classification, patients after RAPE also according to pT classification.

RAPE: the mean period of observation was 37.9 month (6-114), 90 patients being without relapse (78.3%). A biochemical relapse occurred in 25 patients (21.7%). A local progression was confirmed by histology in 11 patients (44% of patients with progression, 9.6% of all patients after RAPE). RT: the mean period of observation was 26.75 months. A histological verification of the relapse was demonstrated in 14 patients (35.9% of patients with progression, 11.7% of all patients treated with RT).

No progression was detected (under comparable period of observation) in patients with lower mean PSA values, a lower Gleason score and a higher probability of localized disease. In contrast, detection of a progression of the disease is significantly higher in patients with higher PSA values, a higher mean value of the Gleason score, higher probability of the locally advance disease or involvement of seminal vesicles. In order to reach good results in the therapy of prostate cancer for long periods of time, the disease must be detected in time and the stage of the disease should be determined exactly with a maximum precision possible. The prognosis in patients with worse "input" parameters is worse from the long-term point of view and these indices should be carefully controlled.