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Cancer Resources > Cancer News > Cancer News from Reuters > Reuters Cancer News > 2009 > November
Short-course hormone therapy improves survival in medium-risk prostate CA
Fran Lowry
Last Updated: 2009-11-03 15:34:37 -0400 (Reuters Health)
CHICAGO (Reuters Health) - Adding four months of hormone therapy to radiation treatment prolongs survival in men with intermediate-risk prostate cancer but not in men with low-risk disease, according to a presentation here at the 51st Annual Meeting of the American Society for Radiation Oncology.
Dr Christopher U. Jones, of Radiological Associates of Sacramento, California, reported that 10-year overall survival was 62% in men who received radiation plus hormone therapy versus 57% in men who received radiation alone (hazard ratio 1.17, p < 0.03). Disease-specific survival was 96% with both treatments and 93% with radiation alone (HR 1.18, p < 0.01). Nearly all of the survival benefit was in the intermediate-risk group.
The phase III Radiation Therapy Oncology Group (RTOG) trial began enrolling low- and intermediate-risk prostate cancer patients in 1994 and finished accrual in 2001. Ultimately, 1,979 men with T1b-T2b prostate cancer and a prostate specific antigen (PSA) level no higher than 20 were randomized either to treatment with radiation therapy plus 4 months of androgen deprivation therapy starting 2 months in advance, or to radiation alone.
The radiation treatment was the standard for the time, and consisted of somewhat lower doses of radiation than are currently used with newer techniques, such as intensity modulated radiation therapy.
In addition to overall and disease-specific survival, the investigators looked at freedom from biochemical failure and re-biopsy results two years after treatment and found that all parameters were significantly improved with hormonal therapy.
The rate of positive re-biopsies was 21% in radiation plus hormone therapy patients, and 39% in radiation alone patients.
"We wanted this information because we hypothesized that if the hormones killed the cancer cells in the prostate, then we would see a lower positive re-biopsy rate, and that is what we did see," Dr. Jones told Reuters Health.
The most important finding from the study is the fact that only intermediate risk patients benefit from the short course of hormone therapy, Dr. Jones continued.
"When we started the study, PSA testing was fairly new and it was only afterwards that we learned how to differentiate low, intermediate and high risk patients based on Gleason score and PSA," he explained. "So now we know that we don't have to subject these low risk men to hormonal treatment, with all of its side effects. We know they do well with radiation alone."
The ongoing RTOG 0815 trial is investigating whether adding hormonal therapy to this subset of patients will continue to show benefit with the newer radiation techniques, he added.
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