External beam radiotherapy for carcinoma of the prostate

Five hundred nineteen patients with prostate cancer were seen in the Radiation Oncology Division of the State University of New York (SUNY) Health Science Center, Syracuse, New York, between 1969 and 1981. The results for the 239 patients treated with radical intent are reported here. All patients received 60 to 70 Gy to the prostate with megavoltage beam irradiation; 142 with a small field (10 X 10 cm) 360 degrees rotational technique for Stage A, B, or C disease and 69 with a four-field pelvic brick technique (followed by a boost to the prostate) for Stage A through C and D1 disease. Twenty-eight patients were treated postoperatively for residual disease after radical prostatectomy or for recurrent tumor. The minimum follow-up time was 5 years. Actuarial 5-year and 7-year survival rates for Stage A (n = 34), B (n = 100), C (n = 63), and D1 (n = 14) were 91% and 76%, 86% and 75%, 67% and 40%, and 46% and 36%, respectively. The corresponding 5-year and 7-year relapse-free survival rates were 72% and 65%, 77% and 60%, 46% and 28%, and 38% and 25%. The local tumor control rates at 5 years were 91%, 85%, 77%, and 62% for Stage A, B, C, and D1, respectively. In our experience, there was no significant difference in relapse-free survival rates for patients who underwent transurethral resection (TURP) versus those who did not (67% versus 78% for Stage B P greater than 0.25] and 38% versus 47% for Stage C P greater than 0.25], respectively). Also there was no significant difference in relapse-free survival rates between large and small field techniques (64% versus 77% for Stage B P greater than 0.25] and 56% versus 41% for Stage C P greater than 0.25], respectively). The 5-year and 7-year actuarial survival rates were 90% and 71%, respectively, for the 15 patients with residual tumor and 58% and 33%, respectively, for the 13 patients treated for postprostatectomy recurrence. Severe complications were documented in only nine patients (3.7%) and mild to moderate complications in 53 patients (22%). Larger fields did not cause a higher rate of complications, although small fields were tolerated better than large fields; the significant acute reaction rate was 27% for large field techniques versus 11% for small field techniques (P greater than 0.01). These results confirm that external beam irradiation is an effective treatment for prostate cancer.