[Total prostatectomy for stage D1 cancers]

Nineteen patients with stage D1 (TXN/MO) prostatic adenocarcinomas were treated with radical prostatectomy and adjuvant radiation therapy. The latter was aortoiliac for stage B tumors and aortoiliac plus pelvic for stage C tumors. No hormonal therapy was associated to this. Lymph node invasion was multifocal in 10 of 19 cases, bilateral in 3 cases, and massive with rupture of the capsule and invasion of the fat surrounding the lymph nodes in 3. The maximum follow-up was 17 years, with a minimum follow-up of 1 year. The dosage of the prostatic specific antigen (PSA) has been an essential element of surveillance since 1987. Eight patients died of their cancer, 11 are alive, including 9 alive and healthy (47%). Among the latter, 5 (26%) are alive without any treatment, with a prostatic antigen level around zero at a follow-up of 6 to 12 years. The review of the literature shows that nonsurgical treatments have a palliative effect for stage D1 tumors, and that surgery alone is not always sufficient. Surgery must be followed by radiation therapy, the only modality likely to complete the effect of radical surgery with the same curative purpose.