Radiation Plus Hormone Therapy Cuts Prostate Cancer Deaths

By Steven Reinberg
17 dec 2008-- Men with locally advanced prostate cancer -- cancer that has spread beyond the wall of the prostate gland -- who undergo radiation plus long-term hormone treatment cut their risk of dying in half, a new study has found.

The addition of radiotherapy kept patients healthy much longer, the Swedish research team concluded. In fact, by adding radiotherapy, men's overall survival was increased by 10 percent with only a modest increase in the risk of radiation-related side effects.

"The study will change practice in the treatment of locally advanced or local aggressive prostate cancer," said lead researcher Dr. Anders Widmark, from the department of radiation sciences and oncology at Umeå University. "These patients should be offered the addition of local radiation treatment."

At least one American expert agreed. "This study just proves what we have suspected for a long time -- namely, that both treatments are needed to get the best results," said Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston.

The report is published in the Dec. 16 online edition of The Lancet.

In this trial, 875 men with locally advanced prostate cancer were randomly assigned to receive either the drug flutamide (Eulexin), to block androgens (male hormones), or hormone therapy along with radiation. Androgens are thought to encourage the spread of prostate cancer, so blocking their effect is a common prostate cancer treatment.

Over an average follow-up of almost eight years, 79 men who received hormone treatment alone died, compared with 37 men who received hormone treatment plus radiation, Widmark's group found.

After 10 years, 23.9 percent of the men in the hormone therapy-only group had died from prostate cancer compared with 11.9 percent of the men in the combined treatment group. In addition, death from any cause was higher in the hormone therapy-only group, (39.4 percent) than in the combined treatment group (29.6 percent), the researchers found.

Moreover, fewer men in the combined treatment group saw a return of their cancer (26 percent) than did men in the hormone-only group (75 percent).

The addition of local treatment with radiotherapy improves survival, Widmark concluded. "These patients are highly curable -- only 10 percent will die of prostate cancer within 10 years," he said. "They should not give up."

Dr. Chris Parker, from the Institute of Cancer Research in Sutton, Surrey, UK, and author of an accompanying editorial in the journal, said that combined radiation and hormone therapy should become standard treatment for men with locally advanced prostate cancer.

"This is a pivotal trial that for the first time demonstrates that radiotherapy improves survival of men with high-risk localized and locally advanced prostate cancer," Parker said. "It is no longer acceptable to regard hormone therapy alone as standard of care."

D'Amico agreed, noting that most U.S. doctors already provide combo therapy as standard treatment for men with locally advanced prostate cancer.

"Combined treatment with radiation and hormonal therapy is necessary to get the best overall survival in men with locally advanced prostate cancer," he said. "The study nails that home."