Advancing Prostate Cancer: Combo Treatment Best
Radiation + Hormone Treatment Doubles Survival in Locally Advanced Prostate Cancer
Dec. 15, 2008 - Adding radiation to hormone therapy doubles survival of
patients with advancing prostate
cancer that hasn't yet spread through the body, a Swedish study
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
The Widmark study, and the Tan/Parker editorial, appear in the Dec. 16 issue
of The Lancet.