Prostate Cancer Survival Improves With Radiotherapy And Androgen Deprivation Therapy

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Academic Journal
Main Category: Prostate / Prostate Cancer
Also Included In: Radiology / Nuclear Medicine
Article Date: 03 Nov 2011 - 6:00 PDT

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An article published Online First in The Lancet reveals that men with locally advanced prostate cancer, which has not spread, who receive radiotherapy (RT) in combination with their androgen deprivation therapy (ADT) are more likely to have a greater overall chance of survival compared with those on ADT alone. According to the authors, Dr Padraig Warde of the Radiation Medicine Program at the Princess Margaret Hospital in Toronto, ON, Canada, Matthew R Sydes at the MRC Clinical Trials Unit in London, UK, and Dr Malcolm Mason at the Cardiff University School of Medicine in the UK and their teams, the advantages of combined treatment should be discussed with all men who suffer from locally advanced prostate cancer that has not spread.

The trial is the first to be adequately equipped to compare RT in combination with ADT to ADT as a stand-alone treatment. After examining a total of 1,205 patients, researchers found that 1,057 patients had locally advanced (T3 or T4) prostate cancer or organ-confined disease (T2). 119 patients were receiving a prostate-specific antigen (PSA) concentration of more than 40 ng/mL or PSA concentration more than 20 ng/mL and 25 patients had a Gleason score of 8 or higher. The researchers randomly assigned 602 patients in the ADT only group and 603 patients in the ADT and RT group to lifelong treatment with a median follow-up at 6 years.

At the time of analysis, 175 patients in the ADT only group and 145 patients in the ADT and RT group had succumbed to their illness.

The findings revealed overall survival rates of 74% in the ADT and RT group compared with 66% in the ADT only group at 7 years. The researchers noted that serious long-term genitourinary or gastrointestinal toxicity from RT was uncommon and recorded low numbers of serious adverse events in each group.

The researchers conclude:

"This trial provides convincing evidence that local control of disease in the prostate improves survival in patients with locally advanced prostate cancer. Our findings suggest that the benefits of the combination of ADT and RT should be discussed with all patients considering a curative treatment approach."

Dr Matthew R Cooperberg from the Department of Urology at the University of California in San Francisco, CA, USA, says in a linked comment:

"This study has provided the strongest evidence to date that androgen deprivation therapy alone for men with high-risk prostate cancer is not adequate. These patients require an aggressive, multimodal approach incorporating prostate-directed local therapy. However, the crucial question - whether the optimum initial strategy should include radiation combined with androgen deprivation therapy, or surgery followed by selective radiation on the basis of pathological findings and early biochemical outcomes - is still open. The definitive answer will only come through trials of men with high-risk disease randomly assigned to receive surgery or radiation as an initial treatment."

Written by Petra Rattue
Copyright: Medical News Today
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