Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for stage C or D1 adenocarcinoma of the prostate: possible beneficial effect of adjuvant treatment.

Limited clinical stage C (T3 NX M0) disease can be treated surgically, and morbidity can be acceptable. When appropriate adjuvant therapy (orchiectomy and/or radiation) is administered, residual cancer can be controlled locally for at least a limited period. The incidence of local progression in pathologic stage C or D1 disease may be negligible after early adjuvant orchiectomy and/or radiation treatment. The combination of immediate orchiectomy and radical prostatectomy has been shown to limit progression significantly (P = .0009) in many patients with D1 (T0-3 N1,2 M0) disease. However, some patients do not respond to this combination treatment, which suggests that systemic dissemination of heterogeneous tumor cells is unresponsive to adjuvant androgen ablation therapy. The DNA ploidy pattern may be a valuable predictor of disease outcome after treatment in stage D1 disease. Other pathologic variables (including acid phosphatase levels) have not been useful in predicting disease outcome or treatment response. Finally, patients with limited clinical stage C disease and those with pathologic C or D1 disease should be enrolled in a prospective randomized protocol so that the possible beneficial effects of adjuvant treatment programs can be evaluated. Apart from the usual pathologic variables and prostate-specific antigen testing, the DNA pattern should be included as a stratification factor.