Results of radical radiotherapy in the treatment of patients diagnosed with prostate cancer a retrospective study

The 57 patients with prostatic adenocarcinoma were evaluated retrospectively, have received radical radiotherapy in İnönü University Department of Radiation Oncology between May 2004- May 2010.Diagnostic modality, tumor stage, neoadjuvant or adjuvant hormonotherapy, perineural invasion, lymph node involment, seminal vesicle invasion, extraprostatic extension, Gleason score, initial PSA level were evaluated.The median age was 67 (48-81). The median PSA level of the patients at diagnosis was 39.9 (4-150) ng/ml. The PSA level was found in 12 patients (21.1 %) PSA?10 ng/ml, in 19 patients (33.3 %) the PSA level was 10-20 ng/ml and in 26 patients (45.6 %) PSA ?20 ng/ml.Pathological diagnosis of all patients were adenocarcinoma.Two patients (3.5 %) were stage I, 48 patients (84.2 %) were stage II, 4 patients (7 %) were stage III and 3 patients (5.3 %) were stage IV.Median Gleason value was 6 (3-10). In 25 patients (43.8 %), Gleason score was under 7, in 11 patients (19.4 %) over 7, and in 21 patients (36.8 %) Gleason score was 7.According to National Comprehensive Cancer Network (NCCN); theree risk groups were determined with pretreatment PSA levels, Gleason score and clinical stages. Due to this patient were seperated to low risk (T1c-2a, Gleason score ?6 and PSA <10 ng/ml), intermediate risk (T2b-T2c and Gleason score 7, PSA 10-20 ng/ml) and high risk groups (T3 or Gleason ?8 and PSA >20 ng/ml). Distribution of risk groups was 8 (14 %) patients low, 42 (73.7 %) patients intermediate, and 7 (12.3 %) patients in high risk group.Transrectal needle biopsy was applied to 42 (73.7 %) patients and transurethral resection performed to 15 (26.3) patients.When the histopathologic properties were, 5 (8.8 %) patients have extraprostatic extension, 4 (7 %) patients have seminal vesicle invasion, 2 (3.5 %) patients have regional lymph node metastases and 22 (38.6 %) patients have perineural invasion.Twenty-eight patients (49 %) with carcinoma of the prostate has a history of additional disease like hypertension, diabetes mellitus, ischemic heart disease, chronic obstructive pulmonary disease, renal failure.The median hemoglobin value before radiotherapy was determined like 13.4 gr/dl, ALP level 143 and LDH level as 256.Three dimensional conformal radiotherapy was treated 38 (66.7 %) patients. Nineteen (33.3 %) patients were treated with convansional methods.Pelvic radiotherapy was treated 23 (40.4 %) patients, 8 (14 %) patients was treated with radiotherapy to prostatic bed, and 26 (45.6 %) patients was treated with radiotherapy to prostate and seminal vesicul.Fiftysix patients have taken median 68 Gy external beam radiotherapy. One patient didn?t continue to treatment after the application of 36 Gy radiotherapy.Fortynine (86 %) patients were applied neoadjuvant hormonotherapy, 51 (89.5 %) patients were received adjuvant hormonotherapy. Fortynine (86 %) patients were received both neoadjuvant and adjuvant hormonotherapy. One patient (1.7 %) was given systemic chemotherapy.Five year overall survival was found 80 % and disease free survival was 79 %.For overall survival Gleason score (p=0.024), extraprostatic extension (p=0.0001), seminal vesicul invasion (p=0.0001), perineural invasion (p=0.04), risk groups (p=0.0001) and tumor stage (p=0.008) were examinated the difference between the two groups and found staistically significant.For disease free survival initional PSA level (p=0.047), Gleason score (p=0.007), seminal vesicul invasion (p=0.0001), extraprostatic extension (p=0.0001), lymph node involvemed (p=0.004), risk groups (p=0.0001), tumor stage (p=0.0001) were examined the difference between the two groups and found statistically significant.The positive effect of neoadjuvant and adjuvant hormonal treatment on overall and disease free survival could not shown.As a result of multivariate analysis for overall survival difference between the groups there was no statistically significant, but for the stage the disease free survival was resulted statistically significant (p=0.047, p<0.05).As a result of the treatment were found to be compatible with the world as a result.