Definitive conformal radiotherapy for localized prostate cancer: a long-term follow-up study

The present study analyzed the clinical long-term outcome of patients with localized prostate cancer after definitive conformal radiotherapy with and without accompanying androgen deprivation (AD).

From 1996 to 2000, 210 patients (median age: 69 years; range: 54-82 years) with a localized prostate cancer (T1/T2: 72%; initial PSA <10: 39%; Gleason <7: 65%) were treated at Hannover Medical School. Fourteen percent of the patients were classified as low risk (LR), 40% as intermediate risk (IR) and 43% as high risk (HR) according to the ASTRO consensus definition. All patients received a conformal radiotherapy of the prostate with a median total dose of 70.2 Gy (<65 Gy: 5%; 65-70 Gy: 36% and >70 Gy: 59%), 177 patients (84%) in combination with temporary AD (median duration 4 month). Biochemical failure after irradiation was defined as three consecutive serum PSA elevations in accordance to the ASTRO consensus statement from 1997. Long-term side-effects were evaluated on the basis of a standardized questionnaire.

The median follow-up was 5.2 years (0.94 to 9.41 years); 54 events (28%) were registered, and 41 patients (20%) were lost to follow-up. The 7-year overall survival (OS) was 75.6% without significant differences in the results regarding the three risk groups (LR: 84.6% vs. IR: 77.2% vs. HR: 73.5%). The 5- and 7-year biochemical disease free survival (bDFS) were 78.3% and 70.0% (LR: 84.6% /84.6% vs. IR: 75.5% /66.7% vs. HR: 77.7% /66.1%).

This study confirms the findings of other investigators and encourages the continuation of risk-adapted treatment policy for localized prostate cancer modified by using higher radiation doses and long-term AD for selected patients with higher risk tumors.