Can radiation therapy and antiandrogen therapy improve survival in recurrent prostate cancer?

The aim of this study was to examine whether combining radiation therapy and antiandrogen therapy improved survival in patients with prostate cancer that is not cured by initial treatment. It was concluded that the combination of radiation therapy and antiandrogen therapy improved survival when compared to radiation therapy alone.

Prostate cancer is often treated with surgical removal of the prostate and surrounding lymph nodes. In some patients, the cancer returns following this treatment. Recurrence can lead to a rise in prostate specific antigen (PSA, a protein found in the blood associated with prostate cancer). This is called a biochemical recurrence.

Radiation is often the first treatment used in patients with a biochemical recurrence. Roughly 50% of patients will see further progression after radiation. Antiandrogen therapy works to block testosterone, a hormone that is found at high levels in prostate cancer. Bicalutamide (Casodex) is an antiandrogen therapy. It is not clear whether combining radiation and antiandrogen therapy would be more effective.

This study examined the safety and effectiveness of a combination of radiation and antiandrogen therapy in men with recurring prostate cancer. 

760 men with recurring cancer after surgical removal of the prostate were involved in the study. 51% were treated with radiation therapy and bicalutamide. 49% were treated with radiation and a placebo (substance with no active effect).  Patients were followed for an average of 13 years.

12-year overall survival (time from treatment until death from any cause) was 76.3% in patients who received radiation and bicalutamide compared to 71.3% in the placebo group. The risk of death from prostate cancer was reduced by 51% when patients were treated with radiation and bicalutamide compared to radiation alone. The risk of metastatic prostate cancer (cancer that has spread) decreased by 37% in those treated with radiation and bicalutamide.

Side effects from radiation were similar between the two groups. 69.7% of men in the bicalutamide group experienced breast enlargement, compared to 10.9% of the placebo group.

This study concluded that treatment with radiation and antiandrogen therapy led to higher survival rates and lower rates of metastasis and death from prostate cancer in patients with recurring prostate cancer. 

Consult with your physician about the risks and benefits of treatment with radiation therapy and antiandrogen therapy.