A Randomized Trial Comparing Radical Prostatectomy Plus Endocrine Therapy versus External Beam Radiotherapy Plus Endocrine Therapy for Locally Advanced Prostate Cancer: Results at Median Follow-up of 102 Months

Background: To investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy. Methods: One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissec-tion and 49 were treated with external beam radiation by linear accelerator with 40–50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined. Results: Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2 % versus 71.1 % for biochemical progression-free rates; P 0.25, 83.5 % versus 66.1 % for clinical progression-free rates; P 0.14, 85.7 % versus 77.1 % for cause-specific survival rates; P 0.06, and 67.9 % versus 60.9 % for overall survival rates; P 0.30), although none of them reached statistical signifi-cance. Erectile dysfunction was recognized in almost all patients as a result of continuou