Failure after primary radiation or surgery for prostate cancer: differences in response to androgen ablation.

Purpose: Androgen ablation is the standard treatment for recurrent and metastatic prostate cancer. Surprisingly few studies have documented the specific results for local and distant failure in patients treated primarily with radiation or radical prostatectomy. We report the long-term outcome of a series of those patients.

Materials And Methods: We followed until death 94 patients in whom primary radiation therapy failed and 67 in whom radical prostatectomy failed. All patients received androgen ablation.

Results: Statistically (p = 0.04) more patients in the radiation group (78%) died of prostate cancer than in the radical prostatectomy group (63%). Of the radiation group with local failure alone 63%, died of prostate cancer at a median of 5.03 years. Of the surgery group with isolated local failure 50% died of cancer at a median of 9.83 years. Of the patients treated with radiation with distant metastasis 93% died of cancer with a median time to death of 2.34 years. Of the patients treated with surgery 69% died of prostate cancer at a median of 3.27 years. The differences in survival between the 2 groups was significant.

Conclusions: This study is unique in providing followup until death of patients treated with radical prostatectomy and radiation who had clinical failure and were treated with androgen ablation. Compelling is the finding that survival after androgen ablation after surgical failure is superior to that for radiation. If confirmed, this would be a significant consideration for future studies of patients in whom primary therapy fails.