Author/Editor		Lee, Jeffrey R; Middleton, Anthony W Jr; Schaeffer, Cameron S; Middleton, George W; Sause, William T
Title		Biochemical failure of surgical stage T3N0 prostate carcinoma with or without adjuvant radiotherapy
Translated title		Biokemično dokazan recidiv karcinoma prostate stadij T3N0 ali brez adjuvantne radioterapije
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 33, št. 2
Publication year		1999
Volume		str. 137-42
Language		eng
Abstract		Background. Patients with extracapsular extension or seminal vesicle involvement of prostate adenocarcinoma are known to have a worse prognosis than patients without these adverse features. Multiple, studies have assessed the impact of adjuvant postoperative radiotherapy on clinical outcome, but there, are fewer studies examining the effect on biochemical (prostate specific antigen or PSA) failure. Methods. This is a retrospective analysis of 100 patients found to have prostate adenocarcinorna extending through the prostatic capsule or involving the seminal vesicles (stage T3) after prostatectomy. Thirty-one patients received adjuvant radiotherapy to the prostatic bed and 69 patients did not receive radiotherapy. Prognostic factors were not evenly distrubuted between the two groups. Mean follow-up was 60 months. Results. Actuarial freedom from PSA failure at 5 and 10 years was 64 % and 31 %, respectively, in the group that received radiotherapy. For the non-irradiated group, the results for the same endpoint were 55%, and 30% at 5 and 10 years (p=.76). The only endpoint analyzed which was significantly improved with adjuvant radiotherapy was clinical local control, which was 95% at 10 years for the radiotherapy group and 65'% at 10 years for the non-irradiated group (p=.03). Among patients who received radiotherapy, biochemical failure was similar when comparing patients with or without seminal vesicle involvement. Potency in patients undergoing nerve sparing prostatectorny was not affected by postoperative radiotherapy. Conclusions. Adjuvant radiotherapy after prostatectomy in patients with stage T3 disease significantly reduced the clinical local failure rate, but did not improve the biochemical failure rate or overall survival. The benefit of adjuvant radiotherapy should be tested in clinical trials.
Summary		Izhodišča. Bolniki, pri katerih žlezni karcinom prostate prerašča ovojnico prostate ali pa zajema semenjak (vesiculo seminalis), imajo slabšo prognozo. Številne študije so obravnavale učinek adjuvantne radioterapije na klinični izhod bolezni, toda redke so proučevale vpliv takšnega zdravljenja na biokemične znake bolezni, (kot je koncentracija prostata specifičnega antigena - PSA), ki kažejo na ponovitev in razvoj bolezni. Metode. Naredili smo retrospektivno analizo 100 bolnikov s karcinomom prostate, kjer je karcinom preraščal ovojnico ali pa zajemal semenjak (stadij T3). Pri vseh je bila narejena prostatektomija. 31 bolnikov je bilo nato zdravljenih še z obsevanjem ležišča prostate, 69 bolnikov pa ni bilo obsevanih. Bolniki so bili obsevani glede na odločitev zdravnika. Neugodni napovedni dejavniki niso bili enakomerno razporejeni v obeh skupinah, več jih je bilo v skupini z radioterapijo. Povprečna doba sledenja je bila 60 mesecev. Rezultati. 5- in 10-letno preživetje brez biokemičnih znakov bolezni je bilo pri bolnikih z radioterapijo 64% in 31%, pri bolnikih brez radioterapije pa podobno 55% in 30% (p = 0,76). Edina razlika, ki smo jo našli med obema skupinama bolnikov, je bila, da so imeli bolniki z adjuvantno radioterapijo zančilno boljšo lokalno kontrolo bolezni, ki je bila po 10 letih 95%, pri bolnikih brez radioterapije pa le 65% (p = 0,03). Ko smo primerjali samo bolnike, ki so imeli s karcinomom zajete semenjake, smo videli, da se je enako pogosto javljal biokemično dokazan recidiv ne glede na radioterapijo. Bolniki niso imeli okvarjene potence, če je bila narejena prostatektomija ob ohranitvi živcev, tudi če so bili kasneje obsevani. Zaključki. Adjuvantna radioterapija po prostatektomiji pri bolnikih s karcinomom prostate T3 značilno zmanjša klinični lokalni recidiv bolezni, toda ne vpliva na biokemično dokazan recidiv in na celokupno preživetje. (Izvleček skrajšan na 2000 znakov).
Descriptors		PROSTATECTOMY PROSTATIC NEOPLASMS NEOPLASM STAGING PROSTATE-SPECIFIC ANTIGEN