[The local relapse of prostatic cancer and initial local treatment]

We treated fifty cases of prostatic cancer that had no distant metastasis and no other primary cancers between October 1983 and September 1990. Our initial treatment for clinical stages A2, B1, B2 included radical prostatectomy, pelvic lymphadenectomy, and bilateral orchiectomy. Staging lymphadenectomy with bilateral orchiectomy was applied to patients with clinical stage C tumor, and if there was no lymph node metastasis, external beam radiation therapy for the prostate was performed. Patients who did not consent to major surgeries or had poor general status or had clinical stage D1 tumor underwent bilateral orchiectomy. Mean observation period was forty-one months. Eleven cases relapsed. Of the eleven cases, ten had local relapse at the diagnosis of relapse (two of them had distant metastasis simultaneously, six of them had distant metastasis later, and two of them had no distant metastasis in the observation period). All these ten cases had no underwent the initial local treatment. The remainder who had underwent radical prostatectomy relapsed with distant metastasis alone. This study suggests that the local relapse tends to precede distant metastasis as the mate of relapse of prostatic cancer excluding stage D2. There is a possibility that initial local treatment is useful improving the prognosis of the patients for clinical stage A2-D1 prostatic cancer.