Dual therapy can control high-risk prostate cancer

By David DouglasMon Aug 27, 10:14 PM ET
High rates of tumor control over the long term are possible with combination treatment using external beam radiation followed by brachytherapy in high-risk prostate cancer patients, according to researchers.
"These patients have been followed longer than any other treatment group reported in the prostate specific antigen era," lead investigator Dr. Michael Dattoli told Reuters Health. Prostate specific antigen (PSA) has become a standard tumor marker for prostate cancer, with high levels correlating with an increased risk of cancer.
"Moreover," he added, "the vast majority of the patients in this study group had extreme adverse features so that surgery would not have even been a treatment option -- certainly not a good option."
As described in the medical journal Cancer, Dattoli of the Dattoli Cancer Center, Sarasota, Florida and colleagues followed 119 intermediate-risk and 124 high-risk patients who had been treated by Dattoli between 1996 and 1998. All but 39 of the patients had at least one risk factor for cancer progression.
The patients underwent 3-dimensional conformal external beam radiation to the pelvis, followed 2 to 4 weeks later by brachytherapy. This involves the implantation of tiny, titanium-sealed radioactive "seeds" into the tumor. As the seeds release radiation, the tumor shrinks and dies.
The average patient follow-up period without treatment failure was 9.5 years. Overall, actuarial freedom from biochemically detected progression after 14 years was 87 percent in patients with intermediate-risk disease and 72 percent in those with high-risk disease.
"The absolute risk of (treatment) failure decreased progressively and fell to 1 percent beyond 6 years after treatment," the team reports.
Despite perceptions that brachytherapy is inappropriate for patients at higher risk of cancer progression, this study strengthens the rationale for brachytherapy as a good option for these patients.
Most patients "are cured without suffering incontinence, while the vast majority have retained their potency," Dattoli noted. "In addition, no patient suffered bowel problems which lasted any longer than 1 to 2 months beyond their treatment."
SOURCE: Cancer August 1, 2007.