Postoperative Radiotherapy for Patients with Carcinoma of the Prostate Undergoing Radical Prostatectomy with Positive Surgical Margins, Seminal Vesicle Involvement and/or Penetration Through the Capsule

No AccessJournal of Urology1 Dec 1987Postoperative Radiotherapy for Patients with Carcinoma of the Prostate Undergoing Radical Prostatectomy with Positive Surgical Margins, Seminal Vesicle Involvement and/or Penetration Through the Capsule Mitchell S. Anscher, and Leonard R. Prosnitz Mitchell S. AnscherMitchell S. Anscher More articles by this author , and Leonard R. ProsnitzLeonard R. Prosnitz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)43656-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Between 1970 and 1983, 442 patients were treated for carcinoma of the prostate at our university medical center. Of the patients 319 underwent radical prostatectomy and 159 (50 per cent) had positive surgical margins and/or seminal vesicle involvement. Of these 159 patients 46 received postoperative irradiation and the actuarial survival was 96, 90 and 90 per cent at 5, 10 and 15 years, respectively. Among the remaining 113 patients who were treated with an operation alone the corresponding figures were 82, 62 and 21 per cent, respectively (p equals 0.02). Considering deaths only of cancer, the surgery only patients had a 15-year actuarial survival of 25 per cent compared to 90 per cent for those who underwent postoperative radiotherapy (p equals 0.07). Actuarial survival free of disease for the surgery plus postoperative irradiation group at 15 years was 40 per cent compared to 28 per cent for the surgery only group (p equals 0.34). Actuarial local control in the irradiated patients was 96 per cent at 15 years versus 32 per cent for the surgery only group (p equals 0.009). Actuarial survival free of distant disease at 15 years was 42 per cent in the irradiated versus 72 per cent in the nonirradiated groups (p equals 0.104). Severe complications attributable to radiation included 3 cases of radiation cystitis, 1 patient with urinary incontinence and leg edema in 9 per cent of the patients undergoing postoperative irradiation compared to 2 per cent of those treated with radical prostatectomy only. Postoperative irradiation appears to be indicated in patients with carcinoma of the prostate who undergo radical prostatectomy and who have positive margins and/or seminal vesicle involvement. Local control is markedly improved (p equals 0.009) and actuarial survival also is benefitted. There was a trend toward decreased deaths of cancer with postoperative irradiation that approached statistical significance. Postoperative irradiation did not improve survival rates free of disease and free of distant disease over those achieved with surgery alone. This finding suggests that while postoperative irradiation may not improve the ultimate cure rate by controlling local disease, early deaths of cancer are reduced resulting in a meaningful increase in survival for these patients. © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByEisenberg M, Karnes R, Kaushik D, Rangel L, Bergstralh E and Boorjian S (2018) Risk Stratification of Patients with Extraprostatic Extension and Negative Lymph Nodes at Radical Prostatectomy: Identifying Optimal Candidates for Adjuvant TherapyJournal of Urology, VOL. 190, NO. 5, (1735-1741), Online publication date: 1-Nov-2013.GROSSFELD G, TIGRANI V, NUDELL D, ROACH M, WEINBERG V, PRESTI J, SMALL E and CARROLL P (2018) MANAGEMENT OF A POSITIVE SURGICAL MARGIN AFTER RADICAL PROSTATECTOMY: DECISION ANALYSISJournal of Urology, VOL. 164, NO. 1, (93-100), Online publication date: 1-Jul-2000.WIEDER J and SOLOWAY M (2018) INCIDENCE, ETIOLOGY, LOCATION, PREVENTION AND TREATMENT OF POSITIVE SURGICAL MARGINS AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCERJournal of Urology, VOL. 160, NO. 2, (299-315), Online publication date: 1-Aug-1998.Fesseha T, Sakr W, Grignon D, Banerjee M, Wood D and Pontes J (2018) PROGNOSTIC IMPLICATIONS OF A POSITIVE APICAL MARGIN IN RADICAL PROSTATECTOMY SPECIMENSJournal of Urology, VOL. 158, NO. 6, (2176-2179), Online publication date: 1-Dec-1997.Cama C, Olsson C, Buttyan R, De Vries G, Wise G and Katz A (2018) Molecular Staging of Prostate Cancer. III. Effects of Cystoscopy and Needle Biopsy on the Enhanced Reverse Transcriptase Polymerase Chain Reaction AssayJournal of Urology, VOL. 157, NO. 5, (1748-1751), Online publication date: 1-May-1997.Ward J, Nowacki M, Sands J, Conner R and Huisman T (2018) Malignant Cytological Washings from Radical Prostatectomy Specimens: A Possible Mechanism for Local Recurrence of Prostate Cancer Following Surgical Treatment of Organ Confined DiseaseJournal of Urology, VOL. 156, NO. 4, (1381-1385), Online publication date: 1-Oct-1996.Goldenberg S, Klotz L, Srigley J, Jewett M, Mador D, Fradet Y, Barkin J, Chin J, Paquin J, Bullock M and Laplante S (2018) Randomized, Prospective, Controlled Study Comparing Radical Prostatectomy Alone and Neoadjuvant Androgen Withdrawal in the Treatment of Localized Prostate CancerJournal of Urology, VOL. 156, NO. 3, (873-877), Online publication date: 1-Sep-1996.Syndikus I, Pickles T, Kostashuk E and Sullivan L (2018) Postoperative Radiotherapy for Stage pT3 Carcinoma of the Prostate: Improved Local ControlJournal of Urology, VOL. 155, NO. 6, (1983-1986), Online publication date: 1-Jun-1996.Formenti S, Lieskovsky G, Simoneau A, Skinner D, Groshen S, Chen S and Petrovich Z (2018) Impact of Moderate Dose of Postoperative Radiation on Urinary Continence and Potency in Patients with Prostate Cancer Treated with Nerve Sparing ProstatectomyJournal of Urology, VOL. 155, NO. 2, (616-619), Online publication date: 1-Feb-1996.Gleave M, Goldenberg S, Jones E, Bruchovsky N and Sullivan L (2018) Biochemical and Pathological Effects of 8 Months of Neoadjuvant Androgen Withdrawal Therapy Before Radical Prostatectomy in Patients with Clinically Confined Prostate CancerJournal of Urology, VOL. 155, NO. 1, (213-219), Online publication date: 1-Jan-1996.Cama C, Olsson C, Raffo A, Perlman H, Buttyan R, McMahon D, Benson M and Katz A (2018) Molecular Stating of Prostate Cancer. II. A Comparison of the Application of an Enhanced Reverse Transcriptase Polymerase Chain Reaction Assay for Prostate Specific Antigen Versus Prostate Specific Membrane AntigenJournal of Urology, VOL. 153, NO. 5, (1373-1378), Online publication date: 1-May-1995.Wieder J, Schmidt J, Casola G, VanSonnenberg E, Stainken B and Parsons C (2018) Transrectal Ultrasound-Guided Transperineal Cryoablation in the Treatment of Prostate Carcinoma: Preliminary ResultsJournal of Urology, VOL. 154, NO. 2, (435-441), Online publication date: 1-Aug-1995.D'Amico A, Whittington R, Malkowicz S, Schultz D, Schnall M, Tomaszewski J and Wein A (2018) A Multivariate Analysis of Clinical and Pathological Factors that Predict for Prostate Specific Antigen Failure after Radical Prostatectomy for Prostate CancerJournal of Urology, VOL. 154, NO. 1, (131-138), Online publication date: 1-Jul-1995.Foster L, Jajodia P, Fournier G, Shinohara K, Carroll P and Narayan P (2018) The Value of Prostate Specific Antigen and Transrectal Ultrasound Guided Biopsy in Detecting Prostatic Fossa Recurrences Following Radical ProstatectomyJournal of Urology, VOL. 149, NO. 5 Part 1, (1024-1028), Online publication date: 1-May-1993.Crawford E (2018) Clinical Trials: Conflicting OpinionsJournal of Urology, VOL. 148, NO. 2 Part 1, (387-388), Online publication date: 1-Aug-1992.Abi-Aad A, Macfarlane M, Stein A and Dekernion J (2018) Detection of Local Recurrence After Radical Prostatectomy by Prostate Specific Antigen and Transrectal UltrasoundJournal of Urology, VOL. 147, NO. 3 Part 2, (952-955), Online publication date: 1-Mar-1992.Kwon E, Loening S and Hawtrey C (2018) Radical Prostatectomy and Adjuvant Radioactive Gold Seed Placement: Results of Treatment at 5 and 10 Years for Clinical Stages A2, B1 and B2 Cancer of the ProstateJournal of Urology, VOL. 145, NO. 3, (524-531), Online publication date: 1-Mar-1991.Link P, Freiha F and Stamey T (2018) Adjuvant Radiation Therapy in Patients with Detectable Prostate Specific Antigen Following Radical ProstatectomyJournal of Urology, VOL. 145, NO. 3, (532-534), Online publication date: 1-Mar-1991.Morton R, Steiner M and Walsh P (2018) Cancer Control following Anatomical Radical Prostatectomy: An Interim ReportJournal of Urology, VOL. 145, NO. 6, (1197-1200), Online publication date: 1-Jun-1991.Jones E (2018) Resection Margin Status in Radical Retropubic Prostatectomy Specimens: Relationship to Type of Operation, Tumor Size, Tumor Grade and Local Tumor ExtensionJournal of Urology, VOL. 144, NO. 1, (89-93), Online publication date: 1-Jul-1990.Green N, Treible D and Wallace H (2018) Prostate Cancer: Post-Irradiation IncontinenceJournal of Urology, VOL. 144, NO. 2 Part 1, (307-309), Online publication date: 1-Aug-1990.Lange P, Lightner D, Medini E, Reddy P and Vessella R (2018) The Effect of Radiation Therapy after Radical Prostatectomy in Patients with Elevated Prostate Specific Antigen LevelsJournal of Urology, VOL. 144, NO. 4, (927-932), Online publication date: 1-Oct-1990.Paulson D, Moul J and Walther P (2018) Radical Prostatectomy for Clinical Stage T1-2N0M0 Prostatic Adenocarcinoma: Long-Term ResultsJournal of Urology, VOL. 144, NO. 5, (1180-1184), Online publication date: 1-Nov-1990.Hudson M and Catalona W (2018) Effect of Adjuvant Radiation Therapy on Prostate Specific Antigen Following Radical ProstatectomyJournal of Urology, VOL. 143, NO. 6, (1174-1177), Online publication date: 1-Jun-1990.Paulson D, Moul J, Robertson J and Walther P (2018) Postoperative Radiotherapy of the Prostate for Patients Undergoing Radical Prostatectomy With Positive Margins, Seminal Vesicle Involvement and/or Penetration through the CapsuleJournal of Urology, VOL. 143, NO. 6, (1178-1182), Online publication date: 1-Jun-1990.Anscher M and Prosnitz L (2018) Re: Postoperative Radiotherapy of the Prostate for Patients Undergoing Radical Prostatectomy with Positive Margins, Seminal Vesicle Involvement and/or Penetration through the Capsule, by D. F. Paulson, J. W. Moul, J. E. Robertson and P. J. Walther, J. Urol., 143: 1178-1182, 1990Journal of Urology, VOL. 143, NO. 6, (1238-1239), Online publication date: 1-Jun-1990.Anscher M and Prosnitz L (2018) Re: Adjuvant Radiotherapy after Radical Prostatectomy: Is it Indicated?, by P. C. Walsh, J. Urol., 138: 1427-1428, 1987Journal of Urology, VOL. 141, NO. 4, (960-961), Online publication date: 1-Apr-1989.Walsh P (2018) Adjuvant Radiotherapy After Radical Prostatectomy: Is it Indicated?Journal of Urology, VOL. 138, NO. 6, (1427-1428), Online publication date: 1-Dec-1987. Volume 138Issue 6December 1987Page: 1407-1412 Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell S. Anscher More articles by this author Leonard R. Prosnitz More articles by this author Expand All Advertisement PDF DownloadLoading ...