Long term results of conservative treatment for stage II—III prostate cancer

The results of treatment of 170 patients with prostate cancer (T2—3N0—1M0—1) who received radiotherapy or radiotherapy plus antiandrogenic therapy from 1998 to 2003 were reviewed. The mean age was 69,5 year. The diagnosis was verified morphologically (Gl — 146 (85%), G2 — 10 (6%), G3 — 14 (8%) patients). The mean level of PSA was 24 ng/ml. Morphologic characteristics of tumors with defining of their differentiation grade according to Glisson scale were studied in 75 patients. Conformation radiotherapy with three dimensional planning was carried out by linear accelerator. Multipetal collimator was used for figured fields construction taking into account the spread of tumor.The total dose of radiation was 70—74 Gy. Only radiation therapy was carried out to 45 patients, whereas in 125 patients the radiotherapy was supplemented by administration of antiandrogenic therapy with Flucin or Zoladex. For initial assessment of tumor extent and evaluation of the treatment effect, we used transrectal ultrasound investigation (TRUSI) with ultrasonographic angiography. According to TRUSI, capsule invasion was found in 25 (16%) patients, which determines the risk of disease progression. Five year disease free survival in the absence of capsule invasion was 92%, whereas the capsule invasion diminishes it to 60%. With increasing levels of PSA long term results deteriorates: 5-year disease free survival was 80% at PSA level below 10 ng/ml, 72% at PSA level 10,1 — 20 ng/ml and 50% at PSA level higher than 20 ng/ml (p=0,36). Capsule invasion found on TRUSI and US angiography, high PSA level and Glisson sum are indications for administration of radiotherapy with antiandrogenic therapy. Unfavorable prognostic factors are found in one third patients over 70 years old, which demands employment of adequate antitumor treatment. Radiation therapy is an effective treatment for prostate cancer: 5-year observed survival was 86%, corrected survival — 91% and disease free survival — 78