Radiation plus hormone therapy improves prostate cancer survival

By Paul Basilio, MDLinx
Published February 3, 2017

Key Takeaways

The addition of hormone therapy to radiation treatment has been shown to improve average long-term survival in men with prostate cancer who have undergone prostatectomy, according to a recent study in the New England Journal of Medicine. The regimen was also found to reduce the frequency of metastasis.

More than 30% of patients with prostate cancer face recurrent disease 1 to 4 years after removal of the prostate gland, according to Howard Sandler, MD, senior author of the study and chair, Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai, Los Angeles, CA.

“Our study indicates that hormonal treatments should be incorporated into the management of men who need radiation therapy after surgery for prostate cancer,” he added.

The study included researchers at 17 medical institutions who followed over 750 patients with prostate cancer in the US and Canada during a 12-year period after they had participated in a randomized clinical trial of the combined treatment between 1998 and 2003.

After 12 years, the incidence of death from prostate cancer was 5.4% for patients who underwent radiation therapy plus hormone treatment vs 13.4% for those who had radiation therapy only. The incidence of metastasis was 14.5% for the group who received both treatments vs 23% in the radiation-only group. Side effects were low and comparable between the groups.

The hormonal treatment in the study was bicalutamide, which was designed to suppress androgens that can stimulate growth of prostate cancer cells. Randomized study participants took the drug daily for 2 years. Bicalutamide has since been supplanted by GnRH agonists in clinical practice, Dr. Sandler said.

However, because both drugs suppress hormone production, he explained the study presents proof of concept that combining hormonal therapy with radiation treatment significantly reduces the rate of metastases and death in the patient group studied.

“This important research has addressed a significant question in the care of patients with prostate cancer and has shown the continued advancement in extending a good quality of life to those patients,” said Steven Piantadosi, MD, PhD, director of the Samuel Oschin Comprehensive Cancer Institute. “Dr. Sandler’s leadership demonstrates how Cedars-Sinai is contributing significantly to improving the outcomes of patients with cancer.”

Prostate cancer is the second most common cancer in men in the US. An estimated 161,300 new cases will be diagnosed in 2017, and approximately 27,000 deaths are expected, according to the American Cancer Society.

Research from the study was supported by the National Cancer Institute of the National Institutes of Health, and by a grant from AstraZeneca.

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