July 23, 2011

For early stage prostate cancer in men with intermediate risk, a large clinical trial has found that combining short term hormone therapy with radiation therapy was more effective than radiation alone.

The prostate is a walnut-sized gland found only in men that surrounds the urethra. The prostate is in front of the rectum, just below the bladder. The prostate tends to enlarge as men age, which may cause the urethra to narrow and restrict the flow of urine. Problems with the prostate include cancer and non-cancerous conditions. Prostate cancer is the most common cancer in men in the United States — 223,307 men were diagnosed with prostate cancer and 29,093 men died from prostate cancer in 2007.

A common test for prostate cancer measures PSA (prostate-specific antigen) level in the blood, which has led to earlier diagnosis of prostate cancer. Most treatments for prostate cancer have focused on later stages of prostate cancer. The recent clinical trial sought to investigate treatments for early stage prostate cancer.

The clinical trial involved almost 2,000 men with early-stage prostate cancer , including almost 400 African-American men (prostate cancer rates are higher for African-American men). The men received either radiation treatment alone or radiation in combination with short-term androgen deprivation therapy (ADT ). ADT involves the administration of drugs that blocks the body’s natural production of the male hormone, testosterone. The ADT used in the study was over a 4 month period (short-term ADT has been used successfully in improving survival of men with later stage prostate cancers). 

The researchers involved with the clinical trial analyzed several outcomes that included lifespan, whether death resulted from prostate cancer or some other cause, and whether the cancer spread. The study found that the participants who were given short-term ADT along with radiation treatment had an improved overall 10-year survival rate of 62% as compared to 57% for those who were treated with radiation alone, and prostate cancer-related deaths were 4% compared to 8%, respectively. The results were similar for both the white male population and African-American population.

Another finding of the study was that the group with an intermediate risk (the study participants were classified as being in one of three defined risk categories: high, intermediate, and low) had the greatest benefit from the combined ADT and radiation therapies: 61% overall 10 year survival rate (54% for those with radiation treatment alone) with 3% prostate cancer-related deaths (10% for those with radiation treatment alone). The researchers suggested that there may be some benefit for men with low-risk disease who receive both ADT and radiation therapy but there is no support for adding ADT to radiation treatment for these men at this time. Some of the side-effects of short-term ADT include hot flashes and higher rates of erectile dysfunction.

Source: NIH

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