Lingering questions have remained about the best way to treat men whose prostate cancer has breached the wall of the prostate gland but hasn't spread much farther (technically, stage T3,N0,M0 prostate cancer).
Hormone therapy -- that is, drugs that cut off the tumor's supply of male hormones -- increases survival. Clinical trials suggest that at this stage of the disease, surgical removal of the prostate (radical prostatectomy) -- offers a smaller survival advantage.
In the U.S., the combination of radiation and hormone therapy is often a first treatment choice for locally advanced prostate cancer. That's a good call, suggests a long-term study of the treatment by Anders Widmark, MD, of Umea University, Sweden, and colleagues.
Ten years after starting treatment, about 24% of men treated with hormone therapy alone had died of prostate cancer. Only about 12% of men treated with the hormone/radiation combination had died of their cancer.
"The improvement was achieved without excess long-term toxicity," Widmark and colleagues note.
Four years after treatment, patients treated with the radiation/hormone combination had significantly more diarrhea than those treated with hormone therapy alone. But 85% of patients said the side effects were acceptable.
In an editorial accompanying the study, Alex Tan, MD, and Chris Parker, MD, of the Institute of Cancer Research, Sutton, Surrey, England, note that the combination treatment may slow progression of "micrometastases." These are existing metastases too small to detect at the time of diagnosis, but which would grow into fatal tumors if left untreated.
Tan and Parker join the Widmark team in recommending that radiation plus hormone therapy become the standard first-line treatment for locally advanced prostate cancer.
The Widmark study, and the Tan/Parker editorial, appear in the Dec. 16 issue of The Lancet.