Stage D1 prostate cancer. A nonrandomized comparison of conservative treatment options versus radical prostatectomy

Untreated Stage D1 prostate cancer is associated with a high progression rate. Various treatment modalities involving monotherapy alone have been associated with dismal results. In this retrospective study, the impact of combination therapy, local (surgery or radiation) and systemic (hormonal), compared with that of monotherapy on disease outcome was evaluated.

The authors reviewed 631 patients who underwent pelvic lymphadenectomy for Stage D1 prostate cancer: 251 had radical prostatectomies and orchiectomies, 78 had radical prostatectomies alone, 97 received local irradiation and underwent orchiectomies, and 60 had orchiectomies alone.

Cause-specific survival rates for prostatectomy-orchiectomy-treated (PO) patients at 5 and 10 years were 91% and 78%, respectively; they were 84% and 54% for irradiation-orchiectomy-treated (IO) patients and 66% and 39% for orchiectomy alone-treated (O) patients, respectively. Controlling for the number of nodes, the difference between PO-treated and IO-treated patients was not significant; the former group had a significantly longer survival than the O-treated patients (P = 0.037). The 5-year and 10-year cause-specific survival rates for prostatectomy alone-treated patients were 91% and 75%, respectively, and 84% and 45% for irradiation alone-treated patients. Thus, cause-specific survival rates in prostatectomy alone-treated patients were significantly better (P = 0.0085).

For patients with Stage D1 prostate adenocarcinoma, radical prostatectomy and local irradiation as local treatments when combined with orchiectomy produce similar outcomes. These results should be verified in a prospective study.