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• W2412188961 abstract "No AccessJournal of Urology1 Dec 1990Management of Stage D1 Adenocarcinoma of the Prostate: The Johns Hopkins Experience 1974 to 1987 Gary D. Steinberg, Jonathan I. Epstein, Steven Piantadosi, and Patrick C. Walsh Gary D. SteinbergGary D. Steinberg More articles by this author , Jonathan I. EpsteinJonathan I. Epstein More articles by this author , Steven PiantadosiSteven Piantadosi More articles by this author , and Patrick C. WalshPatrick C. Walsh More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)39759-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail There is no consensus on the proper management of men with stage D1 adenocarcinoma of the prostate. Although cure is unlikely, many men survive for long intervals apparently free of metastatic disease. Thus, effective palliation of the local lesion with low morbidity is desirable. From 1974 to 1987, 120 consecutive men with stage D1 prostate cancer were treated with 3 primary modes of therapy (mean followup 48 months): 1) expectant therapy (35), 2) external beam radiotherapy (21) and 3) radical prostatectomy (64). These patients were statistically homogeneous as determined by Gleason grade but not by extent of metastatic disease. The over-all 5 and 10-year projected actuarial survival rates for the radical prostatectomy patients were 97 and 62%, respectively, and the apparent clinical survival free of disease at 5 years and 80 months, respectively, was 83 and 68%. The direct disease-specific 10-year survival free of disease was 46%. However, only 3 of 27 patients followed for 3 years or longer had undetectable levels of prostate specific antigen. Using a Cox univariate proportional hazards model several factors appeared to have significant prognostic value including volume of lymph node metastases (macroscopic greater than 2mm.), percentage of positive lymph nodes sampled and frozen section diagnosis. Gleason grade, clinical stage and the number of positive nodes did not have significant prognostic value. Local recurrence requiring an operation was noted in 8 of 35 patients (23%) treated expectantly, 5 of 21 (24%) treated with radiotherapy and 2 of 64 (3%) treated with radical prostatectomy. Significant gastrointestinal or genitourinary complications occurred in 33% of the men treated with radiotherapy and 1.5% of those undergoing radical prostatectomy. Since the introduction of nerve-sparing radical prostatectomy in 1982, potency resumed in 55% of the 33 patients who were potent preoperatively and have been followed 1 year or longer. These data suggest that in properly selected patients radical prostatectomy, although not curative, can provide excellent palliation of the local lesion with acceptable morbidity and that symptomatic local recurrence of prostatic cancer achieved with radiation therapy is identical to the results in men who were managed expectantly. © 1990 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByHeidenreich A, Pfister D and Porres D (2018) Cytoreductive Radical Prostatectomy in Patients with Prostate Cancer and Low Volume Skeletal Metastases: Results of a Feasibility and Case-Control StudyJournal of Urology, VOL. 193, NO. 3, (832-838), Online publication date: 1-Mar-2015.Seiler R, Studer U, Tschan K, Bader P and Burkhard F (2018) Removal of Limited Nodal Disease in Patients Undergoing Radical Prostatectomy: Long-Term Results Confirm a Chance for CureJournal of Urology, VOL. 191, NO. 5, (1280-1285), Online publication date: 1-May-2014.Carlsson S, Tafe L, Chade D, Sjoberg D, Passoni N, Shariat S, Eastham J, Scardino P, Fine S and Touijer K (2018) Pathological Features of Lymph Node Metastasis for Predicting Biochemical Recurrence After Radical Prostatectomy for Prostate CancerJournal of Urology, VOL. 189, NO. 4, (1314-1319), Online publication date: 1-Apr-2013.Kane C, Presti J, Amling C, Aronson W, Terris M and Freedland S (2018) Changing Nature of High Risk Patients Undergoing Radical ProstatectomyJournal of Urology, VOL. 177, NO. 1, (113-117), Online publication date: 1-Jan-2007.Berglund R, Sadetsky N, DuChane J, Carroll P and Klein E (2018) Limited Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy Does Not Affect 5-Year Failure Rates for Low, Intermediate and High Risk Prostate Cancer: Results From CaPSURE™Journal of Urology, VOL. 177, NO. 2, (526-530), Online publication date: 1-Feb-2007.PALAPATTU G, ALLAF M, TROCK B, EPSTEIN J and WALSH P (2018) PROSTATE SPECIFIC ANTIGEN PROGRESSION IN MEN WITH LYMPH NODE METASTASES FOLLOWING RADICAL PROSTATECTOMY: RESULTS OF LONG-TERM FOLLOWUPJournal of Urology, VOL. 172, NO. 5, (1860-1864), Online publication date: 1-Nov-2004.BADER P, BURKHARD F, MARKWALDER R and STUDER U (2018) Disease Progression and Survival of Patients With Positive Lymph Nodes After Radical Prostatectomy. Is there a Chance of Cure?Journal of Urology, VOL. 169, NO. 3, (849-854), Online publication date: 1-Mar-2003.ZINCKE H, LAU W, BERGSTRALH E and BLUTE M (2018) ROLE OF EARLY ADJUVANT HORMONAL THERAPY AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCERJournal of Urology, VOL. 166, NO. 6, (2208-2215), Online publication date: 1-Dec-2001.GHAVAMIAN R, BERGSTRALH E, BLUTE M, SLEZAK J and ZINCKE H (2018) RADICAL RETROPUBIC PROSTATECTOMY PLUS ORCHIECTOMY VERSUS ORCHIECTOMY ALONE FOR pTxN+ PROSTATE CANCER: A MATCHED COMPARISONJournal of Urology, VOL. 161, NO. 4, (1223-1228), Online publication date: 1-Apr-1999.STONE N, STOCK R, PARIKH D, YEGHIAYAN P and UNGER P (2018) PERINEURAL INVASION AND SEMINAL VESICLE INVOLVEMENT PREDICT PELVIC LYMPH NODE METASTASIS IN MEN WITH LOCALIZED CARCINOMA OF THE PROSTATEJournal of Urology, VOL. 160, NO. 5, (1722-1726), Online publication date: 1-Nov-1998.Seay T, Blute M and Zincke H (2018) LONG-TERM OUTCOME IN PATIENTS WITH pTxN+ ADENOCARCINOMA OF PROSTATE TREATED WITH RADICAL PROSTATECTOMY AND EARLY ANDROGEN ABLATIONJournal of Urology, VOL. 159, NO. 2, (357-364), Online publication date: 1-Feb-1998.Davidson P, Hop W, Kurth K, Fossa S, Waehre H and Schroder F (2018) Progression in Untreated Carcinoma of the Prostate Metastatic to Regional Lymph Nodes (Stage T0 to 4,N1 to 3,M0,D1)Journal of Urology, VOL. 154, NO. 6, (2118-2122), Online publication date: 1-Dec-1995.Stone N, Stock R and Unger P (2018) Indications for Seminal Vesicle Biopsy and Laparoscopic Pelvic Lymph Node Dissection in Men With Localized Carcinoma of ProstateJournal of Urology, VOL. 154, NO. 4, (1392-1396), Online publication date: 1-Oct-1995.Wolf J, Cher M, Dall'Era M, Presti J, Hricak H and Carroll P (2018) Original Articles: Prostate Cancer: The Use and Accuracy of Cross-Sectional Imaging and Fine Needle Aspiration Cytology for Detection of Pelvic Lymph Node Metastases Before Radical ProstatectomyJournal of Urology, VOL. 153, NO. 3S, (993-999), Online publication date: 1-Mar-1995.Sgrignoli A, Walsh P, Steinberg G, Steiner M and Epstein J (2018) Prognostic Factors in Men with Stage D1 Prostate Cancer: Identification of Patients Less Likely to Have Prolonged Survival After Radical ProstatectomyJournal of Urology, VOL. 152, NO. 4, (1077-1081), Online publication date: 1-Oct-1994.Zagars G, Sands M, Pollack A and von Eschenbach A (2018) Early Androgen Ablation for Stage D1 (N1 to N3, M0) Prostate Cancer: Prognostic Variables and OutcomeJournal of Urology, VOL. 151, NO. 5, (1330-1333), Online publication date: 1-May-1994.Leandri P, Rossignol G, Gautier J and Ramon J (2018) Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive casesJournal of Urology, VOL. 147, NO. 3 Part 2, (883-887), Online publication date: 1-Mar-1992.Myers R, Larson-Keller J, Bergstralh E, Zincke H, Oesterling J and Lieber M (2018) Hormonal Treatment at Time of Radical Retropubic Prostatectomy for Stage D1 Prostate Cancer: Results of Long-Term FollowupJournal of Urology, VOL. 147, NO. 3 Part 2, (910-915), Online publication date: 1-Mar-1992.Moreno J and Ahlering T (2018) Late Local Complications After Definitive Radiotherapy for Prostatic AdenocarcinomaJournal of Urology, VOL. 147, NO. 3 Part 2, (926-928), Online publication date: 1-Mar-1992. Volume 144Issue 6December 1990Page: 1425-1432 Advertisement Copyright & Permissions© 1990 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Gary D. Steinberg More articles by this author Jonathan I. Epstein More articles by this author Steven Piantadosi More articles by this author Patrick C. Walsh More articles by this author Expand All Advertisement Loading ..." @default.
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