Adding radiation for prostate cancer ups survival
Men with prostate cancer that is beginning to spread live longer and are less likely to die from the disease if they receive a combination of radiation and hormone therapy, a Canadian-led international study suggests.
The study included 1,205 men with prostate cancer that is confined to the walnut-sized gland or has not spread beyond the immediate area.
Participants in Canada, the U.S. and the UK were randomly assigned to hormone therapy alone or hormone therapy plus radiation.
After an average follow-up of six years, cancer-specific survival among the combination group improved by 10 per cent, researchers reported in Wednesday's online issue of the medical journal The Lancet.
"These are the patients, if you look overall, who die of prostate cancer, whereas many of the people who present with earlier-stage disease, they actually will live very long even with or without treatment," said Dr. Padraig Warde, a radiation oncologist at Princess Margaret Hospital in Toronto, who led the study.
At the time of analysis, a total of 320 patients had died, 175 in the hormone only group and 145 in the combination group.
Based on the results, Warde said he believes adding radiation to the treatment plan for these patients should become standard.
He believed the benefits of combined therapy could be even greater now given the use of more targeted radiation techniques that have been developed since the study began in 1995.
Serious long-term side-effects from radiation were uncommon, the researchers said.
There were low numbers of serious adverse events reported in each group. Side-effects included damage to surrounding tissues like the rectum and bladder, which can cause tenderness, some bleeding and diarrhea that didn't tend to last beyond the first year.
The researchers' assertion that the benefit came at no expense to long-term urinary or bowel effects challenged clinical experience and other studies, Dr. Matthew Cooperberg of the urology department at the University of California, San Francisco, said in a commentary accompanying the study.
He was not involved in the research.
"Warde and colleagues have provided the strongest evidence to date that androgen deprivation therapy alone for men with high-risk prostate cancer is not adequate," Cooperberg concluded.
The key question of what's the best strategy to start — radiation and hormone therapy or surgery and then radiation, is still unanswered, Cooperberg said.
In the next stage of the research, Warde's team will test whether a triple combination of chemotherapy along with hormone-suppression and radiation could help even more.
The study was funded by U.S. National Cancer Institute, Canadian Cancer Society Research Institute, UK Medical Research Council and UK National Cancer Research Network.
This year, an estimated 25,500 men in Canada will be diagnosed with prostate cancer and about 4,100 will die of the disease, the Canadian Cancer Society estimates. Fifteen to 20 per cent of cases are the aggressive or high-risk type.
November is moustache month, a movement that encourages men to grow facial hair to raise awareness of prostate cancer and other men's health issues.
