前列腺增生术后发生前列腺癌12例报告

目的：探讨前列腺增生(BPH)术后发生前列腺癌(PCa)的临床特征。方法：报告12例BPH术后发生PCa患者的临床资料，PCa距BPH手术时间为10个月～14年，平均5．6年。患者BPH后因尿频、尿急、排尿困难、血尿、疼痛而再次就诊。检查血清PSA异常11例，前列腺结节8例。B期3例、C期3例、D期6例。12例均行双侧睾丸切除术[白膜下睾丸切除4例，3例行经尿道前列腺电切术(TURP)]。联合雄激素阻断治疗10例；内照射治疗骨痛3例。结果：随访4个月～8年，平均4、5年。死亡3例，病变稳定6例，2例病变进展．1例失访。结论：BPH手术不能预防PCa的发生；血清PSA和直肠指检是BPH术后前列腺癌诊断的主要方法。     

诊断性前列腺电切术对血清PSA异常患者的应用研究

目的:探讨诊断性前列腺电切(TURP)在前列腺增生合并血清PSA异常患者中的应用价值及意义,为临床处理前列腺增生合并血清PSA异常的患者提供一种新的手段。方法:收集符合入组标准的患者71例,总结病理为前列腺癌患者的Gleason评分及预后。对所有患者进行术后随访,检测其TURP术后6个月、1年的PSA值及IPSS评分,分析术后血清PSA值、IPSS的变化,评估TURP在前列腺增生伴血清PSA异常患者中的诊疗效果。结果:①40例前列腺穿刺活检阴性而血清PSA持续异常的患者中,2例术后病理示前列腺腺癌(2/40),Gleason评分为6分,另1例电切后病理示前列腺增生组织,但术后血清PSA持续异常(18μg/L),行2次活检,病理诊断为前列腺癌,Gleason评分6分,3例均行前列腺根治性切除术,术后随访恢复好。31例拒绝活检患者中术后病理示前列腺腺癌9例(9/31)。Gleason评分7⁹分,平均8分,1例行前列腺根治性切除术,8例行内分泌治疗。②59例病理诊断为良性前列腺增生(BPH),其中血清PSA恢复正常者56例,显著降低者3例,IPSS评分有明显改善53例,6例尿道狭窄经过尿扩处理后评分亦有改善。结论:诊断性TURP可提高前列腺癌的早期检出率,改善患者的下尿路症状,且有利于患者血清PSA持续正常化。对血清PSA异常(>4μg/L),伴有下尿路梗阻状态、前列腺穿刺活检阴性的患者可考虑行诊断性TURP。     

良性前列腺增生术后前列腺癌

目的 :提高对前列腺增生术后前列腺癌的认识。　方法 :回顾总结 1 2例 (年龄 6 3～ 82岁 )前列腺增生术后前列腺癌患者的临床资料。前列腺增生术后 1 0个月～ 1 4年 ,平均 5 .6年 ,发现前列腺癌。患者因排尿困难、血尿、疼痛而再次就诊。发现前列腺特异抗原 (PSA)异常 1 1例 ,前列腺结节 8例。B期 3例、C期 3例、D期 6例。 1 2例均行睾丸切除术 ,其中 1 0例加用雄激素受体阻断剂 ,3例行经尿道前列腺切除术 (TURP)。　结果 :随访 4个月～ 8年 ,平均 4 .5年。死亡 3例 ,病变稳定 6例 ,2例病变进展。　结论 :前列腺增生手术不能预防前列腺癌的发生 ,血清PSA和直肠指检是前列腺增生术后前列腺癌诊断的主要方法     

前列腺良性增生术后发生前列腺癌2例

目的提高对前列腺增生术后发生前列腺癌的认识。方法回顾总结2例(年龄分别74岁、80岁)前列腺增生术后发生前列腺癌患者的临床资料。前列腺增生术后14个月、28个月(平均2.1年)分别发现前列腺癌。患者因排尿困难、血尿、疼痛而再次就诊。均发现前列腺特异抗原(PSA)异常,前列腺结节。2例均行睾丸切除术,术后加用雄激素受体阻断剂。结果随访4个月～2年,病变稳定。结论前列腺增生摘除手术不能预防前列腺癌的发生,血清PSA检测、直肠指检和前列腺多点穿刺活检是前列腺增生术后前列腺癌诊断的主要方法。     

＂诊断性＂TURP在BPH伴血清PSA异常患者中的应用价值

目的：探讨“诊断性”TURP在BPH伴血清PSA异常患者中的应用价值及意义。方法：对BPH伴血清PSA异常患者行“诊断性”TURP,然后对手术切除的前列腺组织行病理检查,按照病理诊断结果分为PCa组和BPH组,分别评估PCa组患者的临床分期及Oleason评分和BPH组患者TURP术后3个月、6个月、1年及随访结束时血清PSA、IPSS评分、生活质量等。结果：87例BPH伴血清PSA异常者行“诊断性”TURP,病理诊断为PCa5例,Gleason评分5～8分,肿瘤分期T1a～T2a,行PCa根治性切除术;病理诊断为BPH82例,出院后均随访2～4年,其中血清PSA恢复正常者77例,显著下降者3例,持续异常者2例,IPSS评分均有明显降低。结论：对血清PSA异常患者,“诊断性”TURP可有助于诊断PCa并对下尿路症状的改善和血清PSA的正常化具重要作用。     

大体积良性前列腺增生患者高值PSA临床分析

目的　探讨大体积良性前列腺增生 (BPH)患者高值血清前列腺特异抗原 (PSA)的来源。　方法　对 2 7例术前PSA值 8.1～ 75 .1ng/ml,直肠指诊前列腺≥Ⅲ° ,超声测量前列腺体积 >5 0ml,无前列腺癌 (PCa)迹象的排尿困难患者 ,采用耻骨上前列腺切除术及术后PSA追踪检测方法 ,分析术后PSA值变化的原因以及术前高值PSA的来源。　结果　 2 7例切除腺体 4 0～ 1 85g ,平均 82 .7g。病理检查 2例发现PCa灶 ,2 5例未发现PCa灶。术后 1个月内 1例有PCa灶者PSA上升 ,2 6例迅速下降至正常范围。 2 4例获随访 1 7～ 5 7个月 ,PSA 0 .0 8～ 2 .39ng/ml,平均 1 .1 6ng/ml。　结论　大体积BPH患者的高值PSA多源于前列腺移行区增生腺体 ,而非源于外周区     

前列腺上皮内瘤诊治分析(附13例报告)

目的　探讨前列腺上皮内瘤 (PIN)的临床特征、诊断和处理。　方法　分析 13例PIN患者的临床资料。良性前列腺增生合并PIN 4例 (HGPIN 1例 ,LGPIN 3例 ) ,行TURP手术 3例 ,耻骨上经膀胱前列腺摘除术 1例 ;前列腺癌并发PIN 8例 (均为HGPIN) ,行前列腺根治性切除术 5例 ,TURP手术 3例 ;体检发现LGPIN 1例 ,因血PSA持续升高 ,TURP术后给予雄激素全阻断治疗。　结果　 13例均经病理确诊 ,血PSA检测、直肠指诊和经直肠B超等检查对PIN诊断无意义。 4例BPH合并PIN患者均健康存活 (3～ 5年 ) ,1例 1年后随访活检发现进展为前列腺癌 ,行前列腺根治性切除术 ;5例前列腺癌并发PIN患者随访 2～ 5年后健康存活 ,1例死于其它疾病 ,2例失访 ;体检发现者 3个月后血PSA明显下降。　结论　病理检查是诊断PIN的惟一方法。对PIN应进行雄激素全阻断治疗并密切随访 ,定期穿刺活检是早期发现PIN恶变的有效方法。     

良性前列腺增生手术切除后继发前列腺癌6例

目前不论何种手术方式均不能完全彻底地切除增生的前列腺组织 ,残余的腺体组织中有可能发生前列腺癌。笔者统计了 1 990～ 2 0 0 0年我院诊断前列腺癌的患者中曾因良性前列腺增生 (BPH)行前列腺切除的病例 ,并就其临床数据予以分析和讨论。1　临床资料1 2 1例前列腺癌患者中有 6例曾因BPH行前列腺切除术。 6例患者年龄 5 1～ 83岁 ,平均 72岁。均经穿刺活检病理诊断证实。诊断前列腺癌距手术时间间隔为 1～ 1 6年 ,平均 8年。有 3例发生在术后 4年内 ,1例于术后 9年发生 ,另 2例则为 1 0年以后发生。肿瘤分期 :A2 期 2例 ;B1 期 1例 ;C…     

血清PSA、游离PSA与良性前列腺增生临床的相关性研究

目的分析血清前列腺特异性抗原(PSA)及游离前列腺特异性抗原(fPSA)与良性前列腺增生(BPH)临床的相关性。方法应用化学发光微粒子免疫分析法(CMIA)对BPH患者血清PSA、fPSA进行检测。结果入选的40例患者病理均为BPH。PSA>4ng/ml者,术后随访1～3个月,平均2.5个月,PSA值均降至0.02ng/ml以下,可除外前列腺癌(PCa)病例。PSA<4ng/ml者16例(40%),4～10ng/ml者14例(35%),>10ng/ml者10例(25%);fPSA>0.934ng/ml者22例(55%)。血清PSA、fPSA水平与前列腺总体积(PV)、前列腺移行区体积(TZV)、年龄及国际前列腺症状评分(IPSS)呈正相关。结论本组血清fPSA与PV、TZV、年龄、IPSS评分有更强相关性。BPH患者血清PSA、fPSA水平升高的相关因素与前列腺总体积及移行区增大、高龄及高IPSS评分有关。     

低血清PSA型前列腺癌的回顾性研究

目的:探讨低血清前列腺特异抗原(prostate-specific antigen,PSA)型前列腺癌的临床特证。方法:回顾性分析10例低血清PSA型前列腺癌患者的临床资料:10例患者因下尿路梗阻或骨痛或体检异常入院,入院时血清PSA值平均为1.968ng/ml。直肠指诊、经直肠前列腺超声、MRI检查异常,行穿刺和(或)前列腺电切术,其中2例前列腺小细胞癌患者,1例行药物去势+抗雄激素治疗,另1例行前列腺电切术+药物去势+抗雄激素治疗;7例前列腺腺癌患者,2例行药物去势+抗雄激素治疗,1例行手术去势+抗雄激素治疗,2例行腹腔镜前列腺癌根治术,2例行前列腺电切+药物去势+抗雄激素治疗;1例鳞癌患者行前列腺电切术+药物去势+抗雄激素治疗。结果:术后经病理检查确诊。7例前列腺腺癌Gleason评分,6例≥7分,1例=4分。10例患者中,T3期以上患者8例,其中3例有骨转移。10例患者术后平均随访18个月,4例死亡,3例病情进展,3例病情无进展。结论:低血清PSA型前列腺癌发病多隐匿,恶性度较高,诊断及随访不依赖血清PSA;内分泌治疗效果不理想,术后随访时需定期行影像学检查,以明确疾病有无进展。     

Poorly differentiated prostate cancer treated with radical prostatectomy: long-term outcome and incidence of pathological downgrading

PURPOSE: Patients with high grade (Gleason score 8 to 10) prostate cancer on biopsy are at high risk for cancer recurrence after local treatment, such as radiation therapy and radical prostatectomy. We examined long-term outcomes in patients with high grade prostate cancer on biopsy who were treated with radical prostatectomy alone. We also investigated the impact on outcomes of changes in the radical prostatectomy Gleason score. MATERIALS AND METHODS: Of 5,662 patients who underwent radical prostatectomy during 20 years 238 had a biopsy Gleason score of 8 to 10. We analyzed the rate of biochemical recurrence in this subgroup according to the Gleason grade of cancer in the radical prostatectomy specimen. RESULTS: Ten-year biochemical recurrence-free probability in the cohort was 39%. However, 45% of patients (95% CI 38 to 51%) with Gleason score 8 to 10 cancer on biopsy had a Gleason score of 7 or less in the radical prostatectomy specimen. These patients had a 10-year biochemical recurrence-free probability of 56% compared to 27% in those with a final Gleason score that remained 8 to 10 (p = 0.0004). On multivariate analysis neither prostate specific antigen nor biopsy features, including total number of cores, number of cores with cancer and percent of cancer in the cores, was a significant predictor of downgrading. However, clinical stage and biopsy Gleason score were significant with 58% of cT1c and 51% of biopsy Gleason score 8 cancers downgraded. Almost 65% of cT1c Gleason score 8 cancers were downgraded compared to 11% of cT3 Gleason score 9 cancers. CONCLUSIONS: Patients diagnosed with poorly differentiated prostate cancer (Gleason score 8 to 10) on biopsy do not uniformly have a poor prognosis. Of the patients 39% remain free of cancer recurrence 10 years after radical prostatectomy. Of these cancers 45% have a lower Gleason score in the radical prostatectomy specimen and a correspondingly more favorable long-term outcome. Predictors of downgrading are lower clinical stage (cT1c) and Gleason score 8 in the biopsy specimen.     

Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and follow-up

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis. MATERIAL AND METHODS: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data. RESULTS: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53-79 years). The PSA at the time of diagnosis was <4ng/ml in 8 cases; 4-10ng/ml in 16 cases and >10ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19-150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy. CONCLUSIONS: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during follow-up.     

Early results of radical prostatectomy and adjuvant endocrine therapy for prostate cancer with or without preoperative androgen deprivation

Background : The effects of preoperative androgen deprivation were explored in the patients who received radical prostatectomy and subsequent adjuvant endocrine therapy for prostate cancer.
Methods: Stage A₂, B or C prostate cancers were randomized to one of two groups: (i) group I ( n = 90), who received androgen deprivation (leuploride and chlormadinone acetate) for 3 months preoperatively followed by radical prostatectomy and adjuvant endocrine therapy (leuploride only); and (ii) group II ( n = 86), who underwent the surgery followed by 3 month androgen deprivation and subsequent adjuvant endocrine therapy. The effects of preoperative androgen deprivation on clinical relapse (serum prostate specific antigen (PSA) > 1.98 ng/mL, local recurrence or distant metastasis) and PSA relapse (PSA > 0.2 ng/mL) were evaluated at 2 years after randomization.
Results: There was no significant difference in clinical or PSA relapse-free survival and quality of life measures between the two groups, although relapses occurred significantly more frequently in patients who had more advanced stages, higher pretreatment PSA values or lower histologic differentiation in either group. Subgroup analysis indicated that clinical relapse-free survival in stage C cancer tended to be better in patients with preoperative androgen deprivation than in those patients without it ( P < 0.1).
Conclusions : Preoperative androgen deprivation may be beneficial for stage C prostate cancer patients receiving radical prostatectomy and adjuvant endocrine therapy over the 2 year observation period. A longer follow up is needed to clarify the exact extent of benefit in terms of survival and quality of life.     

Salvage radical prostatectomy for radiorecurrent prostate cancer: morbidity revisited

PURPOSE: With the advent of prostate specific antigen (PSA) testing and transrectal ultrasound guided prostate biopsy there has been stage migration in the diagnosis of prostate cancer, so that more younger men are being diagnosed with organ confined prostate cancer. Many patients elect radiation therapy, while some have recurrent or new prostate cancer with absent systemic disease and life expectancy greater than 10 years. We present our experience with salvage radical prostatectomy in these cases. MATERIALS AND METHODS: Between 1995 and 2000, 6 men treated with curative intent with radiotherapy for prostate cancer were subsequently treated with salvage surgery for clinically localized prostate cancer. All men had biopsy proved recurrent or persistent prostate cancer, increasing serum PSA, no evidence of systemic disease at surgery and life expectancy greater than 10 years. We assessed the morbidity associated with this procedure and compared results to those in the contemporary literature. RESULTS: Six patients underwent salvage radical prostatectomy. Initial pre-radiation PSA was 4.5 to 15.7 ng./ml. Pre-radiation disease was clinical stage T1c in 5 cases and B2 in 1. The interval from radiotherapy to repeat biopsy was 12 to 48 months. A mean of 6.3 months after local recurrence was detected and before salvage radical prostatectomy was performed 4 patients underwent androgen deprivation therapy. Mean operative time was 195 minutes, intraoperative blood loss was 680 cc, and hospital stay and catheterization time were 3.2 and 13.8 days, respectively. There were no rectal injuries. All 6 patients are impotent, 5 are continent and 1 has mild stress incontinence. There was biochemical failure in 1 case 36 months after salvage radical prostatectomy and no evidence of recurrence in the remaining 5 at a mean followup of 27 months. CONCLUSIONS: Salvage radical prostatectomy is a technically challenging procedure. In the past it was associated with a high incidence of rectal injury, urinary incontinence and anastomotic stricture. The results of our relatively small series are encouraging and concur with those of recent studies that the morbidity of salvage radical prostatectomy is lower than previously reported. We believe that salvage radical prostatectomy may be considered a reasonable treatment option in appropriate patients with radiorecurrent prostate cancer.     

Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy--a propensity scoring approach

PURPOSE: We performed a retrospective cohort study using propensity score analysis to calculate long-term survival in patients with prostate cancer with Gleason score 8 or greater who were treated with conservative therapy, radiation therapy and radical prostatectomy. MATERIALS AND METHODS: Between January 1, 1980 and December 31, 1997, 3,159 patients in the Henry Ford Health System were diagnosed with clinically localized prostate cancer. Of these patients 453 had a Gleason score of 8 or greater in the biopsy specimen and they were the cohort. The end points were overall and prostate cancer specific survival. Propensity score analysis was used to more precisely compare the 3 treatments of observation, radiation and radical prostatectomy. Median patient followup was longer in the radical prostatectomy arm than in the conservative treatment and radiation therapy arms (68 months vs 52 and 54, respectively). RESULTS: Of the 453 patients 197 (44%) were treated conservatively, 137 (30%) received radiation therapy and 119 (26%) underwent radical prostatectomy. Using propensity scoring analysis median overall survival for conservative therapy, radiation and radical prostatectomy was 5.2, 6.7 and 9.7 years, respectively. Median cancer specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. The risk of cancer specific death following radical prostatectomy was 68% lower than for conservative treatment and 49% lower than for radiation therapy (p<0.001 and 0.053, respectively). CONCLUSIONS: Survival of men with high grade prostate cancer can be improved by radical prostatectomy or radiation therapy.     

Trend and variation in treatment of localized prostate cancer in the southern part of The Netherlands, 1988-1996. Regional Study Group for Urological Oncology IKZ, Eindhoven.

OBJECTIVE: To investigate whether the large increase in the incidence of early prostate cancer has led to subsequent increased application of curative treatment and whether similar patterns of treatment were observed in the various hospitals in the area of this investigation. METHODS: Using the Eindhoven Cancer Registry, all patients newly diagnosed with prostate cancer between 1988 and 1996 in the southern part of The Netherlands were included in the study. Initial treatment was analyzed for 4,073 patients, of whom the proportion with clinically localized prostate cancer (T1-T3, M0-Mx) increased from 52% in 1988-1990 to 74% in 1994-1996. RESULTS: The proportion of patients with localized prostate cancer treated with radical prostatectomy increased from 11 to 34% among patients under age 70. Especially in 1994-1996, a group of smaller hospitals (n = 11) with a rather low proportion of patients treated by radical prostatectomy (5-52%) could be distinguished from a group of larger hospitals (n = 5) with a large proportion of patients treated by radical prostatectomy (35-67%). Radiotherapy was a more frequent option in hospitals with low radical prostatectomy rates. The proportion of patients aged 70-74 years undergoing radiotherapy increased from 31 to 41%. Over 80% of the patients aged 75 years or older were treated conservatively during the whole study period. CONCLUSION: Increased detection of localized prostate cancer resulted in increased application of curative treatment for patients under 70 years of age, but a substantial variation was observed between hospitals in the application of radical prostatectomy and radiotherapy.     

Long-term Results of Definitive Treatment in Elderly Patients with Localized Prostate Cancer

Background: The indication and effectiveness of definitive local treatment for prostate cancer in patients with a limited life expectancy remains to be established. This study is a retrospective analysis of the long-term clinical outcome of elderly patients with localized prostate cancer treated by radiotherapy or a radical prostatectomy.
Methods: From 1982 to 1992, 37 patients with localized prostate cancer, aged 70 years or older, were treated initially by a pelvic lymphadenectomy and then with either external radiotherapy (n = 1 7) or a radical retropubic prostatectomy (n = 20). Lymph node metastasis was negative in all the cases, and no patients received hormonal treatment after the lymphadenectomy. The outcome of all patients was evaluated in June 1997.
Results: The 10-year overall and relative survival rates for the radiotherapy group were 27% and 85%, which were not significantly different from the rates of patients in the prostatectomy group (38% and 74%, respectively). The 5-year progression free rates for the radiotherapy group and the prostatectomy group were 63% and 95%, respectively ( P= 0.06).
Conclusion: In elderly patients with localized prostate cancer, the superiority of a radical prostatectomy over radiotherapy was not demonstrated in terms of either overall or relative survival rates, although the progression rate tended to be higher in patients in the radiotherapy group. The indication of definitive treatment in elderly patients should be further studied incorporating a quality of life assessment.     

Trends in repeat prostatectomy after surgery for benign prostate disease: application of record linkage to healthcare outcomes

OBJECTIVE: To compare the risk of repeat prostatectomy for benign prostatic hyperplasia (BPH) in a population-based cohort of 19 598 men in Western Australia treated by transurethral resection of the prostate (TURP) or open prostatectomy over a 16-year period. PATIENTS AND METHODS: The Western Australian Health Services Research Linked Database was used to extract all hospital morbidity data, death records and prostate cancer registrations for men who had prostate surgery for BPH in 1980-95. The cumulative incidence of first repeat prostatectomy calculated using the actuarial life-table and incidence-rate ratios of the first repeat prostatectomy, comparing TURP and open prostatectomy, were obtained using Cox regression. RESULTS: The cases comprised 18 464 TURPs and 1134 open prostatectomies, from which there were 1095 subsequent repeat prostatectomies. After adjustment for calendar time, age and admission type, the incidence rate of the first repeat prostatectomy was up to 2.30 times higher (95% confidence interval, 1.62-3.27) after initial TURP than for initial open prostatectomy. The absolute risks at 8 years for TURP was 6.6%, and was 3.3% for open prostatectomy. CONCLUSION: The absolute risk of a repeat prostatectomy for TURP and open prostatectomy were consistent with the best reported international experience. There was evidence that the risk in 1990-95 had declined compared with earlier periods, despite a shift towards more closed procedures. The differential risks of repeat prostatectomy should be explained to patients and considered in the development of clinical guidelines, notwithstanding the advantages of TURP over open prostatectomy in terms of surgical morbidity and cost.     

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.