The Frequency and Morbidity of Local Tumor Recurrence after Definitive Radiotherapy for Stage C Prostate Cancer

Abstract

Radiotherapy is reported to provide good control of locally advanced prostate cancer. However, few long-term studies have assessed the morbidity related to local tumor recurrence in patients treated with radiotherapy alone (without hormonal manipulation). To determine the frequency and severity of morbidity related to local recurrence we reviewed the course of all patients with clinical stage C prostate cancer treated at our institution between 1966 and 1979 with bilateral pelvic lymph node dissection, radioactive gold seed implantation and external beam irradiation therapy to the prostate. Of the 121 patients 60% died and the 40% still alive at the time of review were followed for a mean of 8.1 years (range 3.3 to 14.8 years). Over-all, 64 patients (53%) had local recurrence, which was defined as a clinical event causing signs or symptoms and was proved by biopsy. On an actuarial basis the risk of local recurrence was 43 +/- 10% (mean +/- 2 standard errors) at 5 years and 74 +/- 11% at 10 years. Any symptomatic episode requiring active intervention or causing morbidity was denoted an adverse event. There were 162 adverse events among the 73 patients (2.2 adverse events per patient): 69% of these were severe (requiring surgical intervention) and 55% were chronic (more than 3 months in duration). The most common cause of an adverse event was bladder outlet obstruction requiring transurethral resection of the prostate (44 patients); 16 patients (13%) became incontinent. Hydronephrosis developed in 24 patients (20%). Local recurrence after definitive radiotherapy for our patients with stage C prostate cancer was common and was associated with serious morbidity, frequently requiring surgical intervention. Radiotherapy alone may not be sufficient to provide long-term local control of stage C prostate cancer.

Management of Patients with Biochemical Recurrence After Local Therapy for Prostate Cancer

“…28,29 Local disease growth following radiation has been associated with decreased time to metastatic progression and increased prostate cancer specific mortality 30,31 and may also be associated with urological morbidity including hematuria, bladder outlet obstruction and chronic pain. 32 Salvage prostatectomy is the only salvage therapy for radiation failure shown to provide long-term cancer control with a 10-year cancer-specific survival of 70 to 77%. 33,34 The likelihood of benefit from salvage prostatectomy correlates with the original likelihood of cure had surgery been the preferred option.…”

Salvage therapy for locally recurrent prostate cancer after external beam radiotherapy

“…Few patients with radiorecurrent prostate cancer undergo local salvage therapies despite the fact that local persistence of disease (as determined by prostate biopsy) is identified in up to 70% of patients with an increasing PSA after radiotherapy [12,13•]. Local recurrence is associated with a fourfold increased risk of developing distant metastases [14] and is a cause of serious morbidity, frequently requiring surgical intervention [14][15][16].…”

Radical prostatectomy for the patient with locally advanced prostate cancer

“…Holzman et al [41] reviewed the clinical course of 121 patients with locally advanced prostate cancer who were treated with radiotherapy. At a mean follow-up of 8.1 years, 41% of the patients had prostate cancer-related death.…”