In a nutshell
This study aimed to evaluate whole pelvic radiotherapy (WPRT) compared to prostate only radiotherapy (PORT) with hormonal therapy (HT) before or after radiation for patients with intermediate- or high-risk prostate cancer. This study found that HT before radiotherapy and WPRT had superior long-term survival without cancer growing or spreading (progression-free survival; PFS).
Some background
Radiotherapy and hormonal therapy (HT) are treatment options for prostate cancer. Radiotherapy can be given to just the prostate (PORT) or to the whole pelvis (WPRT). HT can be given in a neoadjuvant schedule. This means that HT is started before and during radiotherapy (NHT). Adjuvant HT (AHT) is started and given during and after radiotherapy.
Whether WPRT or PORT combined with NHT or AHT gives the best outcomes with the most acceptable side effects is still under investigation.
Methods & findings
This study included 1322 patients with intermediate-risk and high-risk prostate cancer. They were randomly assigned to one of four treatment groups. Group 1 had NHT and WPRT. Group 2 had NHT and PORT. Group 3 had WPRT and AHT. Group 4 had PORT and AHT. Patients were followed up for an average of 8·8 years.
The 10-year PFS was 28·4% for group 1, 23·5% for group 2, 19·4% for group 3 and 30.2% for group 4. Group 1 had a 38% lower risk of cancer returning compared to group 2.
Bladder and bowel side-effects were the most commonly reported in this study. These included pain on urination or diarrhea. This was more common in group 1 (9%) and group 2 (8%) compared to group 3 (7%) and group 4 (5%).
The bottom line
This study found that NHT plus WPRT improved progression-free survival compared with NHT plus PORT and WPRT plus AHT at long-term follow-up in patients with intermediate- and high-risk prostate cancer.
What’s next?
Discuss the different types of radiotherapy and hormone therapy with your doctor.
Published By :
The Lancet. Oncology
Date :
Oct 10, 2018
