Evaluating the impact of long term androgen deprivation therapy and radiotherapy after prostate surgery in patients with high risk of relapse

The study looked at the effects of long term androgen deprivation therapy (LT-ADT), pelvic lymph node radiotherapy (PLNRT) and prostate bed radiotherapy (PBRT) in patients with prostate cancer and high risk of recurrence after prostate surgery. They found an increase in survival without cancer worsening in these patients. 

Prostate cancer is a cancer of the prostate gland. It is commonly fueled by androgens (male sex hormones such as testosterone). Complete removal of the prostate gland (radical prostatectomy; RP) is usually done when the tumor has not spread to other organs but is causing distressing symptoms. These symptoms include difficulty passing urine and erectile dysfunction. Urine retention is particularly of concern as it leads to backwards flow of urine. This leads to kidney failure. 

Even so, RP may not completely eliminate the disease. If there are tumor cells in the lymph nodes that drain the prostate gland, the cells may spread to other surrounding organs leading to recurrence. Additional therapy such as LT-ADT and targeted radiotherapy (RT) may be required. ADT is hormonal treatment that blocks androgens. RT can be targeted to the prostate bed (PBRT) or to the close-by lymph nodes (PLNRT).

The effectiveness of combining LT-ADT, PBRT, and PLNRT in patients with prostate cancer at high risk for recurrence after RP remains under investigation.

43 patients with high-risk prostate cancer were recruited. All patients have had a RP. They were given LT-ADT, PLNRT, and PBRT about 71 weeks after surgery. They were followed up for an average of 5.2 years.

There were no deaths reported after the five years. All patients were alive without cancer worsening at 3 years. 78% of patients were alive without cancer worsening after 5 years.

The main side effect was low testosterone levels which occurred in 24%. All patients experienced erectile dysfunction (an inability to get and maintain an erection firm enough for intercourse) during LT-ADT.

The study found that LT-ADT, PLNRT, and PBRT after prostate surgery in patients with high-risk prostate surgery was well tolerated and improved survival without cancer worsening. 

The study had a small sample size and a brief follow up period. It also lacked a control group for comparison.