Fifteen-year survival and recurrence rates after radiotherapy for localized prostate cancer

Purpose: To determine 15-year survival and recurrence rates after radiotherapy for localized prostate cancer. Methods: One hundred thirty-six patients with clinically localized prostate cancer treated from 1966 to 1974 with interstitial gold seed and external-beam irradiation were evaluated to determine the probability of recurrence and survival greater than or equal to 15 years after therapy. All patients were surgically staged with pelvic lymphadenectomy and none received hormonal therapy before relapse. Results: Overall, 60 patients (44%) have never recurred, although 57% (34 of 60) of these same patients have died of causes other than prostate cancer. Local progression developed in 39% of patients and distant metastases in 42%. At 15 years, the probability of dying of prostate cancer was 33% +/- 8% (% +/- 2 SE) and of all causes wets 72% +/- 8%. In clinical stage A2 and B, 29% +/- 9% of patients died of their cancer within 15 years, compared with 57% +/- 21% in stage C1, while only 18% +/- 8% with clinical stage A2 and B and negative lymph nodes died of cancer within this period. In contrast, the prostate cancer mortality rate at 15 years was high for patients with positive nodes regardless of the stage of the primary tumor (73% for A2 and B; 71% for C1). Patients with nodal metastases, poorly differentiated tumors, and advanced local disease all had a significantly (P < .0001) increased risk of cancer death. Conclusion: The cancer-specific mortality rate for patients with stage A2 and B tumors and negative nodes compares favorably with other series of patients treated with radiation therapy and greater than or equal to 15 years' follow-up evaluation. While local progression rates ore high and associated with a substantial risk of prostate cancer death, many patients live with the disease and ultimately die of causes other than prostate cancer. (C) 1997 by American Society of Clinical Oncology.