In a nutshell
This study compared the benefit of combining different local therapies with hormone therapy for metastatic prostate cancer. Researchers reported a survival benefit for patients treated with surgery or intensity modulated radiation therapy (a type of radiation therapy) before hormone therapy.
Some background
Hormone therapy is currently the standard of care for advanced prostate cancer and cancer that has spread to distant organs (metastatic). It targets male hormones (such as testosterone) active in cancer growth. Hormone therapy can be combined with local therapies for a more intensive intervention. These include prostate surgery and radiation. They are often administered before hormone therapy.
Radiation therapy works by targeting radioactive beams at the tumor site. There are different types of radiation treatment. Conformal radiation therapy (CRT) is a type of radiation where the beams are shaped to match the tumor. Intensity modulated radiation therapy (IMRT) is a specialized form of CRT. It allows the radiation beams to closely fit the area of the tumour with minimal damage to surrounding tissue.
Which local therapy offers the greatest survival benefit when combined with hormone therapy has not been fully studied.
Methods & findings
The aim of this study was to determine the benefits of combining prostate surgery, IMRT, or CRT with hormone therapy for metastatic prostate cancer.
The records of 4,069 patients with metastatic prostate cancer were analyzed. 47 patients underwent prostate surgery before hormone therapy. 88 patients were previously treated with IMRT. 107 patients received CRT. 3,827 patients were treated with hormone therapy alone. Patients were followed for an average of 20 months.
2,872 deaths occurred during the study period. 72% of these were due to prostate cancer.
The 3-year overall survival rate (proportion of patients who have not died from any cause since treatment) was 73% for patients treated with surgery and 72% for IMRT patients. This was significantly greater compared to CRT (37%) and hormone therapy alone (34%).
72% of patients treated with prostate surgery did not die from prostate cancer at 3 years. This was similar for patients treated with IMRT (82%). 3-year prostate cancer-specific survival was 49% for patients in the CRT group and 46% for patients treated with hormone therapy.
Overall, men treated with prostate surgery had a 57% reduced risk of mortality due to any cause compared to men treated with hormone therapy alone. IMRT lowered this risk by 55%. The risk of mortality from prostate cancer was reduced by 52% for men treated with surgery and by 62% for men treated with IMRT. CRT was not associated with a survival benefit when compared to hormone therapy alone.
After accounting for factors such as age, year of diagnosis, ethnicity, marital status, cancer markers, and hormone therapy, prostate surgery reduced prostate cancer mortality risk by 45%. This was 53% for IMRT.
The bottom line
The authors concluded that local therapy with prostate surgery and IMRT, but not CRT, was associated with a survival benefit for metastatic prostate cancer patients.
The fine print
Some patients may have received treatment after hormone therapy, which could have influenced survival.
Published By :
Journal of Urology
Date :
Feb 21, 2015
