The effect of standard treatments in patients with favorable and unfavorable prostate cancer

The authors aimed to determine the effect of common treatments on prostate cancer-specific mortality for patients with intermediate-risk prostate cancer. 

Intermediate-risk prostate cancer is cancer that has grown through and/or out of the prostate. It can be further classified as favorable or unfavorable.

Unfavorable cancer patients will have two or more risk factors. Risk factors include prostate specific antigen (a protein elevated in the blood indicating the presence of prostate cancer) levels of 10-40 ng/mL, a Gleason score (scoring system that compares the differences between normal and cancerous cells) of more than 7 or tissue samples taken from the cancer site that are more than 50% positive for cancer.

Favorable cancer can be classified as patients with one risk factor or less. 

The aim of this study was to determine the effects of common treatments on patient prostate cancer-specific mortality.

2,510 patients were used in this study with an average follow-up of 7.78 years. 75.78% had favorable disease and 24.22% had unfavorable disease.

Patients with favorable disease received brachytherapy (radioactive seed placed directly at the tumor site to kill cancer cells) alone or hormone therapy (treatment that targets the male sex hormones active in prostate cancer, such as testosterone) followed by brachytherapy.

Patients with unfavorable disease received either hormone therapy or radiation therapy (beam of radiation focused on the tumor site that kills cancer cells without damaging healthy cells) before receiving brachytherapy.

In total 14.58% of patients died. 7.92% of patients died from prostate cancer (55.17% had unfavorable disease, 44.83% had favorable disease). Prostate cancer-specific mortality (patients who died from prostate cancer following treatment) was significantly reduced in patients with unfavorable disease who received hormone therapy. Hormone therapy patients with unfavorable disease had a 66% reduced risk of dying from prostate cancer compared to patients who received radiation therapy.

Patients with unfavorable disease who received radiation therapy and brachytherapy had higher rates of prostate cancer-specific mortality (3.87% at 8 years) compared to patients who received hormone therapy and brachytherapy (1.43% at 8 years).

Hormone therapy did not reduce the risk of prostate cancer-specific mortality for patients with favorable disease.

The authors concluded that hormone therapy before brachytherapy was superior to radiation therapy in patients with unfavorable disease. They also concluded that hormone therapy did not affect prostate cancer-specific mortality rates in patients with favorable disease.

If you are considering brachytherapy and have concerns about the benefit of hormone or radiation therapy, please consult you doctor.