UROLOGICAL ONCOLOGY

Long-Term Followup of a Randomized Study of Locally Advanced Prostate Cancer Treated with Combined Orchiectomy and External Radiotherapy versus Radiotherapy Alone
Granfors T, Modig H, Damber JE, Tomic R
Department of Urology, Central Hospital, Vasteras, Sweden
J Urol. 2006; 176: 544-7

• Purpose: In a randomized study we compared the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for locally advanced prostate cancer. Patients who were treated only with radiotherapy initially underwent castration therapy at clinical progression, providing the opportunity to compare immediate vs deferred endocrine intervention.
• Materials And Methods: In this prospective study 91 patients with locally advanced prostate cancer were randomized to receive external beam radiotherapy (46) or combined orchiectomy and radiotherapy (45) after surgical lymph node staging. Survival rates were calculated.
• Results: During 14 to 19 years of followup 87% of the patients in the radiotherapy group and 76% in the combined orchiectomy and radiotherapy group died (log rank p = 0.03). Prostate cancer mortality was 57% and 36%, respectively (log rank p = 0.02). The difference in favor of combined treatment was mainly caused by lymph node positive tumors. For node negative tumors there was no significant difference in the survival rates.
• Conclusions: Immediate androgen deprivation should be considered instead of deferred endocrine treatment started at clinical progression for prostate cancer with spread to regional lymph nodes. While awaiting evidence from randomized trials, one should consider full dose radiotherapy for local control of locally advanced prostate cancer even when it is lymph node positive.
  
  
• Editorial Comment
  This paper gives the long-term results of a simple but well-done trial: immediate or deferred hormone ablative treatment in patients undergoing external beam radiation therapy (ERBT) after surgical lymph node staging.
  The answer is clear-cut: immediate hormone ablative therapy is better than deferred therapy with regard to survival. This difference was most predominant in lymph node positive patients. In conclusion, these data and other papers strongly support the use adjuvant endocrine treatment in radiotherapy against prostate cancer.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany