Is conventional or hypofractionated radiation therapy better for the treatment of prostate cancer?

This study compared two different types of radiation therapy after prostate surgery for prostate cancer, hypofractionated postprostatectomy radiation therapy (hypoPORT) and conventional postprostatectomy radiation therapy (coPORT). Results showed that hypoPORT may be effective in prostate cancer control and with similar side effects as coPORT.

One of the main treatments for prostate cancer is surgical removal of the prostate (prostatectomy). In patients whose cancer has spread in the tissues near the prostate, radiation therapy is given after surgery. This is called postoperative radiation therapy (PORT). Conventional PORT (coPORT) involves small daily doses of radiation for 7-8 weeks. One of the main side effects from coPORT is damage caused to other organs such as bladder and rectum. 

To help lower damage to other organs, hypofractionated PORT (hypoPORT) was designed. HypoPORT involves dividing the total dose of radiation in larger doses over a shorter period of time. There has been little research to compare the safety an effectiveness of hypoPORT to coPORT in patients with prostate cancer.

461 patients with prostate cancer at two hospitals were included. Patients received either hypoPORT (167 patients) or coPORT (294 patients). Measured outcomes included early and late side effects and treatment efficacy through the PSA level (a protein found in the prostate tissue). The average follow-up for all patients was 38.6 months.

Early side effects to the urinary tract were more common in the hypoPORT group (22%) than in the coPORT group (8%). There was no difference in the short-term or long-term side effects to the bowels between the two treatments.

The 4-year biochemical progression-free survival (the percentage of patients alive without the PSA level growing 4 years later) was higher in the hypoPORT group (78.4%) compared to the coPORT group (64.8%). The percentage of patients without cancer spreading to distant organs at 4 years was similar for the hypoPORT and the coPORT groups (95.4% and 92.2%).

This study determined that hypoPORT was associated with better prostate cancer control compared to coPORT, but with worse urinary side effects.

Patients in the hypoPORT group had worse urinary functions at the beginning of the study. This might have influenced the side effects of therapy.