10-year survival and quality of life in patients with high-risk pN0 prostate cancer following definitive radiotherapy

Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1074-83. doi: 10.1016/j.ijrobp.2007.04.031. Epub 2007 Aug 20.


Purpose: To evaluate long-term overall survival (OS), cancer-specific survival (CSS), clinical progression-free survival (cPFS), and health-related quality of life (HRQoL) following definitive radiotherapy (RT) given to T(1-4p)N(0)M(0) prostate cancer patients provided by a single institution between 1989 and 1996.

Methods and materials: We assessed outcome among 203 patients who had completed three-dimensional conformal RT (66 Gy) without hormone treatment and in whom staging by lymphadenectomy had been performed. OS was compared with an age-matched control group from the general population. A cross-sectional, self-report survey of HRQoL was performed among surviving patients.

Results: Median observation time was 10 years (range, 1-16 years). Eighty-one percent had high-risk tumors defined as T(3-4) or Gleason score (GS) > or =7B (4+3). Among these, 10-year OS, CSS, and cPFS rates were 52%, 66%, and 39%, respectively. The corresponding fractions in low-risk patients (T(1-2) and GS < or =7A [3+4]) were 79%, 95%, and 73%, respectively. Both CSS and cPFS were predicted by GS and T-classification; OS was associated with GS only. High-risk, but not low-risk, patients had reduced OS compared with the general population (p < 0.0005). When pelvis-related side effects were included in multivariate analyzes together with physical function and pain, sexual, urinary, and bowel function were not independently associated with self-reported global quality of life.

Conclusions: Despite surgically proven (p)N(0), RT with dosage <70 Gy as monotherapy does not give satisfactory CSS rates after 10 years in patients with T(3-4) or GS > or =7B.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Case-Control Studies
  • Disease Progression
  • Erectile Dysfunction / physiopathology
  • Follow-Up Studies
  • Health Status
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Norway
  • Prostatic Neoplasms / mortality*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / radiotherapy*
  • Quality of Life*
  • Radiotherapy, Conformal*
  • Survival Analysis
  • Urination Disorders / physiopathology