Radical pelvic surgery and radiation therapy in the management of localized carcinoma of the prostate.

A total of 181 prostatic cancer patients under radiation monotherapy were tested for the therapeutic effect of pelvic lymphadenectomy (PLA). Sixty-seven belonging to the pN0 category formed a highly selective group and presented a 89% rate of 7-year survival. Localized radiation therapy with pelvic irradiation (81 patients) with conventional exclusion of lymphogenic macrometastases in the probable presence of micrometastases produced equally good results. Extended pelvic irradiation in cases of conventionally verified regional lymphogenic macrometastases remained without therapeutic effect. The combination of PLA with pelvic irradiation, when regional metastases have already occurred (23 patients), may be suited for localizing the tumor process, since the survival rates showed no significant difference compared to those of the pN0 group. For that reason and also because of the difficulty in determining the N category accurately by conventional methods, it is recommended to perform PLA prior to radiation monotherapy.