Which therapy is more effective at boosting radiotherapy effectiveness for patients with localized prostate cancer?

This study compared whether radiotherapy (RT) was more effective when combined with hormone therapy or brachytherapy (BT) for patients with localized prostate cancer (PC). The authors found that patients who received hormone therapy and RT survived for longer.

External beam radiotherapy (EBRT) focuses beams of radiation from the outside on cancer cells to kill them. It is effective for patients with localized PC. Recent evidence suggests that EBRT results can be improved by adding a second therapy. 

Brachytherapy (BT) is another type of RT where the radiation is placed directly into the tumor. Hormone therapy interferes with hormone signals, such as androgens, that cancer uses to grow. It is unclear if EBRT is more effective when combined with BT or hormone therapy in patients with localized prostate cancer.

9 trials examining the effectiveness of EBRT + BT or EBRT + hormone therapy in patients with localized PC were analyzed. 4663 patients received EBRT with or without hormone therapy and were followed for 114 months on average. 718 patients received EBRT with or without BT and were followed for 110.3 months on average. 

Hormone therapy increased patients’ chances of survival by 30% compared to EBRT alone. In patients with high-risk PC, hormone therapy increased patients’ chances of survival by 34% and by 27% in patients with intermediate-risk PC compared to EBRT alone.

BT slightly increased patients’ chances of survival by 6% compared to RT alone.

EBRT + hormone therapy increased patients’ chances of survival by 32% compared to EBRT + BT.  A second type of analysis confirmed that there was an 88% chance that EBRT + hormone therapy was superior to EBRT + BT.

It was estimated that after 10 years 28% of patients who received EBRT + hormone therapy would reach mortality versus 41% of patients who received EBRT + BT.

The authors concluded that EBRT + hormone therapy is superior to EBRT + BT for patients with localized PC.

There were unequal numbers of patients in each treatment group which may not allow a fair comparison of treatments. The use of data from other studies limits analysis as different studies used different setups, including the EBRT dose.