Results of local and/or systemic adjuvant therapy in the management of pathological stage C or D1 prostate cancer following radical prostatectomy.

Between 1976 and 1984, 47 of 108 patients (44%) who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinical stage A2 or B adenocarcinoma of the prostate were found to have pathological stage C or D1 disease. A total of 31 consecutive patients with pathological stage C disease received 45 to 55 Gy. adjuvant external beam radiation postoperatively. Actuarial 5 and 10-year survival rates free of disease were 92%, with a local recurrence rate of 3% and a distant recurrence rate of 6% at a mean followup of 5 years. Sixteen consecutive pathological stage D1 cancer patients received 45 to 60 Gy. adjuvant external beam radiation alone (4), adjuvant cytotoxic chemotherapy alone with cyclophosphamide (5) or combined adjuvant radiation and chemotherapy (7). Actuarial 5 and 10-year survival rates free of disease were 86% with no local recurrences and a distant recurrence rate of 12% at a mean followup of 5 years. These results provide further evidence to support the use of adjuvant external beam radiation therapy in the management of pathological stage C disease. Our preliminary results suggest that an aggressive, multidisciplinary approach is warranted in pathological stage D1 disease and that adjuvant chemotherapy, with or without adjuvant radiation, may have a role in prolonging survival free of disease in this high risk group.