External-beam radiation therapy for clinically localized prostate cancer: patterns of care studies in the United States.

Data are presented from the Patterns of Care Study and other sources that define the role of external-beam irradiation in the management of localized prostate cancer as practiced in the United States as a whole. Patients must be treated with complex treatment techniques and high-energy linear accelerators and careful adjustment of radiation dose. Transurethral resection of the prostate should be avoided in the intermediate and poorly differentiated subgroup of stage C patients. The excellent 5- and 10-year survival for patients treated by radiation therapy is demonstrated for all stages of prostate cancer and for T1 or early stage B patients. It is noted that the national averages for survival have improved between 1973 and 1978. Stages A2 and B patients with negative lymph node dissections show freedom from recurrence that is equal to patient reports for radical surgery. Complications resulting from radiation therapy were modest, and potency was maintained in 73% of the patients. Adjuvant irradiation is necessary for pathologic stage C patients after recovery from surgery. Radiation therapy is equally effective though less costly than surgery for early prostate cancer. A particular need of future research is the study of the patterns of care in the United States regarding the surgical management of prostate cancer so that health professionals can determine if this care is generally available throughout the United States and if good outcome and acceptable morbidity result after it is given.