Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate

Prostate Cancer and Prostatic Diseases volume 9, pages 254–260 (2006)Cite this article

Abstract

To determine the timing and patterns of late recurrence after radical prostatectomy (RP) alone or RP plus adjuvant radiotherapy (RT). Between 1970 and 1983, 159 patients underwent RP for newly diagnosed adenocarcinoma of the prostate and were found to have positive surgical margins, extracapsular extension and/or seminal vesicle invasion. Of these, 46 received adjuvant RT and 113 did not. The RT group generally received 45–50 Gy to the whole pelvis, then a boost to the prostate bed (total dose of 55–65 Gy). In the RP group, 62% received neoadjuvant/adjuvant androgen deprivation vs 17% in the RT group. Patients were analyzed with respect to timing and patterns of failure. Only one patient was lost to follow-up. The median follow-up for surviving patients was nearly 20 years. The median time to failure in the surgery group was 7.5 vs 14.7 years in the RT group (P=0.1). Late recurrences were less common in the surgery group than the RT group (9 and 1% at 10 and 15 years, respectively vs 17 and 9%). In contrast to recurrences, nearly half of deaths from prostate cancer occurred more than 10 years after treatment. Deaths from prostate cancer represented 55% of all deaths in these patients. Recurrences beyond 10 years after RP in this group of patients were relatively uncommon. Despite its long natural history, death from prostate cancer was the most common cause of mortality in this population with locally advanced tumors, reflecting the need for more effective therapy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Anscher MS, Prosnitz LR . 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. J Urol 1987; 138: 1407–1412.

    Article  CAS  Google Scholar 

  2. Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2005; 366: 572–578.

    Article  Google Scholar 

  3. Catton C, Gospodarowicz M, Warde P, Panzarella T, Catton P, McLean M et al. Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 2001; 59: 51–60.

    Article  CAS  Google Scholar 

  4. Cheng WS, Frydenberg M, Bergstralh EJ, Larson-Keller JJ, Zincke H . Radical prostatectomy for pathologic stage C prostate cancer: influence of pathologic variables and adjuvant treatment on disease outcome. Urology 1993; 42: 283–291.

    Article  CAS  Google Scholar 

  5. Choo R, Hruby G, Hong J, Hong E, DeBoer G, Danjoux C et al. Positive resection margin and/or pathologic T3 adenocarcinoma of prostate with undetectable postoperative prostate-specific antigen after radical prostatectomy: to irradiate or not? Int J Radiat Oncol Biol Phys 2002; 52: 674–680.

    Article  Google Scholar 

  6. Hagan M, Zlotecki R, Medina C, Tercilla O, Rivera I, Wajsman Z . Comparison of adjuvant versus salvage radiotherapy policies for postprostatectomy radiotherapy. Int J Radiat Oncol Biol Phys 2004; 59: 329–340.

    Article  Google Scholar 

  7. Kalapurakal JA, Huang CF, Neriamparampil MM, Small Jr WJ, Pins MR, Mittal BB et al. Biochemical disease-free survival following adjuvant and salvage irradiation after radical prostatectomy. Int J Radiat Oncol Biol Phys 2002; 54: 1047–1054.

    Article  Google Scholar 

  8. Kamat AM, Babaian K, Cheung MR, Naya Y, Huang SH, Kuban D et al. Identification of factors predicting response to adjuvant radiation therapy in patients with positive margins after radical prostatectomy. J Urol 2003; 170: 1860–1863.

    Article  Google Scholar 

  9. Mayer R, Pummer K, Quehenberger F, Mayer E, Fink L, Hackl A . Postprostatectomy radiotherapy for high-risk prostate cancer. Urology 2002; 59: 732–739.

    Article  Google Scholar 

  10. Morris M, Dallow K, Zeitman A, Park J, Althausen A, Heney N et al. Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 1997; 38: 731–736.

    Article  CAS  Google Scholar 

  11. Nudell D, Grossfeld G, Weinberg V, Roach III M, Carroll P . Radiotherapy after radical prostatectomy: treatment outcomes and failure patterns. Urology 1999; 54: 1049–1057.

    Article  CAS  Google Scholar 

  12. Pacholke HD, Wajsman Z, Algood CB, Morris CG, Zlotecki RA . Postoperative adjuvant and salvage radiotherapy for prostate cancer: impact on freedom from biochemical relapse and survival. Urology 2004; 64: 982–986.

    Article  Google Scholar 

  13. Peschel R, Robnett T, Hesse D, King C, Ennis R, Schiff P et al. PSA based review of adjuvant and salvage radiation therapy vs observation in postoperative prostate cancer patients. Int J Cancer (Radiat Oncol Invest) 2000; 90: 29–36.

    Article  CAS  Google Scholar 

  14. Taylor N, Kelly JF, Kuban DA, Babaian RJ, Pisters LL, Pollack A . Adjuvant and salvage radiotherapy after radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 2003; 56: 755–763.

    Article  CAS  Google Scholar 

  15. Tsien C, Griffith KA, Sandler HM, McLaughlin P, Sanda MG, Montie J et al. Long-term results of three-dimensional conformal adjuvant and salvage radiotherapy after radical prostatectomy. Urology 2003; 62: 93–98.

    Article  Google Scholar 

  16. Valicenti R, Gomella L, Ismail M, Mulholland S, Strup S, Petersen R et al. Durable efficacy of early postoperative radiation therapy for high-risk pT3N0 prostate cancer: the importance of radiation dose. Urology 1998; 52: 1034–1040.

    Article  CAS  Google Scholar 

  17. Vicini F, Ziaja E, Kestin L, Brabbins D, Stromberg J, Gonzalez J et al. Treatment outcome with adjuvant and salvage irradiation after radical prostatectomy for prostate cancer. Urology 1999; 54: 111–117.

    Article  CAS  Google Scholar 

  18. Wiegel T, Bottke D, Willich N, Piechota H-J, Souchon R, Sloeckle M et al. Phase III results of adjuvant radiotherapy (RT) versus ‘wait and see’ (WS) in patients with pT3 prostate cancer following radical prostatectomy (RP) (ARO96-02/AUO AP 09/95). J Clin Oncol 2005; 23: 381s.

    Article  Google Scholar 

  19. Swanson GP, Thompson IM, Tangen C, Miller G, Lucia MS, Troyer DA et al. Phase III randomized trial of adjuvant radiation therapy versus observation in patients with pathologic T3 prostate cancer (SWOG 8794). Int J Radiat Oncol Biol Phys 2005; 63: S1.

    Article  Google Scholar 

  20. Paulson DF, Moul JW, Robertson JE, Walther PJ . Postoperative radiotherapy of the prostate for patients undergoing radical prostatectomy with positive margins, seminal vesicle involvement and/or penetration through the capsule. J Urol 1990; 143: 1178–1182.

    Article  CAS  Google Scholar 

  21. American Joint Committee on Cancer Manual for Staging of Cancer. JB Lippincott Co: Philadelphia, 1992.

  22. Anscher M, Robertson C, Prosnitz L . Adjuvant radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate: 10 year update. Int J Radiat Oncol Biol Phys 1995; 33: 37–43.

    Article  CAS  Google Scholar 

  23. Kaplan EL, Meier P . Nonparametric estimations from incomplete observations. J Am Statist Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  24. Cox D . Regression models and life tables. JR Stat Soc B 1972; 34: 187–202.

    Google Scholar 

  25. Anscher MS, Prosnitz LR . Multivariate analysis of factors predicting local relapse after radical prostatectomy – possible indications for postoperative radiotherapy. Int J Radiat Oncol Biol Phys 1991; 21: 941–947.

    Article  CAS  Google Scholar 

  26. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Tomaszewski JE, Wein A . Prostate specific antigen outcome based on the extent of extracapsular extension and margin status in patients with seminal vesicle negative prostate carcinoma of Gleason score < or =7. Cancer 2000; 88: 2110–2115.

    Article  Google Scholar 

  27. Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC . Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003; 169: 517–523.

    Article  Google Scholar 

  28. Corn BW, Winter K, Pilepich MV . Does androgen suppression enhance the efficacy of postoperative irradiation? A secondary analysis of RTOG 85-31. Radiation Therapy Oncology Group. Urology 1999; 54: 495–502.

    Article  CAS  Google Scholar 

  29. Eulau SM, Tate DJ, Stamey TA, Bagshaw MA, Hancock SL . Effect of combined transient androgen deprivation and irradiation following radical prostatectomy for prostatic cancer. Int J Radiat Oncol Biol Phys 1998; 41: 735–740.

    Article  CAS  Google Scholar 

  30. Katz MS, Zelefsky MJ, Venkatraman ES, Fuks Z, Hummer A, Leibel SA . Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer. J Clin Oncol 2003; 21: 483–489.

    Article  Google Scholar 

  31. King CR, Presti Jr JC, Gill H, Brooks J, Hancock SL . Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes? Int J Radiat Oncol Biol Phys 2004; 59: 341–347.

    Article  Google Scholar 

  32. Song DY, Thompson TL, Ramakrishnan V, Harrison R, Bhavsar N, Onaodowan O et al. Salvage radiotherapy for rising or persistent PSA after radical prostatectomy. Urology 2002; 60: 281–287.

    Article  Google Scholar 

  33. Wiegel T, Bressel M, Carl UM . Adjuvant radiotherapy following radical prostatectomy – results of 56 patients. Eur J Cancer 1995; 31A: 5–11.

    Article  CAS  Google Scholar 

  34. Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff RO et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002; 360: 103–106.

    Article  CAS  Google Scholar 

  35. Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D . Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 1999; 341: 1781–1788.

    Article  CAS  Google Scholar 

  36. Pilepich MV, Winter K, Lawton CA, Krisch RE, Wolkov HB, Movsas B et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma – long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 2005; 61: 1285–1290.

    Article  CAS  Google Scholar 

  37. Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: 1591–1597.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond, VA, USA

    M S Anscher, R Clough & L R Prosnitz

  2. Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA

    C N Robertson, P Dahm, P Walther, C F Donatucci, D M Albala, L Sun & J W Moul

  3. Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA

    P Febbo & D J George

Authors
  1. M S Anscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Clough
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C N Robertson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L R Prosnitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Dahm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Walther
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C F Donatucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D M Albala
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P Febbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D J George
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. L Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. J W Moul
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M S Anscher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Anscher, M., Clough, R., Robertson, C. et al. Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate. Prostate Cancer Prostatic Dis 9, 254–260 (2006). https://doi.org/10.1038/sj.pcan.4500903

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.pcan.4500903

Keywords

This article is cited by

Search

Advanced search

Quick links