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High-Risk Prostate Cancer Responds Well to Radiotherapy Plus Androgen Deprivation

Reuters Health • The Doctor's Channel Newscast

NEW YORK (Reuters Health) – Contrary to a historically pessimistic outlook, high-risk prostate cancer can be controlled with moderate high-dose radiation treatment and prolonged androgen-deprivation therapy (ADT).

That word comes from a team at the University of Texas MD Anderson Cancer Center in Houston. “Specifically,” they state, “symptomatic local failure is uncommon, and few men die of prostate cancer even 10 or more years after treatment.”

Dr. Quynh-Nhu Nguyen and colleagues point out that dose escalation has improved results of external beam radiotherapy (EBRT)and extended androgen suppression therapy has had additive benefits in men with high-risk prostate cancer; i.e., a clinical classification of T3 or higher, a Gleason score of 8 or greater, or a pre-treatment PSA level of 20 ng/mL or more.

In the June 24 online issue of Cancer, the authors describe long-term outcomes in 741 such patients treated at their center between 1987 and 2004. Within that cohort, 375 men received low-dose EBRT (less than 75.6 Gy) and no ADT; 122 men received low-dose radiotherapy plus ADT for at least 2 years; 71 received high-dose radiotherapy (at least 75.6 Gy) without ADT; and 173 received high-dose radiotherapy and ADT.

In general, outcomes were better with more intensive treatment. For example, 10-year overall survival rates in the four groups were 57%, 67%, 72% and (projected) 72%, respectively. As another example, corresponding clinical failure-free rates at 5 years were 67%, 90% 88% and 92%

As the authors point out, another important long-term endpoint is the development of symptomatic recurrences that affect quality of life. “The 10-year symptomatic local failure rate was only 2% for all patients,” they report.

Summing, Dr. Nguyen and colleagues conclude: “Our analyses indicate that long-term ADT in combination with high-dose external beam radiation therapy produces outcome results far superior to that of lingering historical perceptions.” They add, “Information such as this is critical for counseling patients on treatment options.”

In an accompanying editorial, however, Dr. Sean P. Elliott points out that the report omits any mention of treatment-related adverse effects. “We should not, as the authors do here, declare one treatment regimen superior to another without proper attention to adverse effects,” he writes.

Dr. Elliott, at the University of Minnesota in Minneapolis, adds: “Each patient’s tolerance threshold for cancer recurrence and adverse effects will dictate an individualized approach to cancer management. The patient deserves to have the information needed to make an informed decision.”

Source: Long-term outcomes for men with high-risk prostate cancer treated definitively with external beam radiotherapy with or without androgen deprivation
Editorial: Long-term outcomes for men with high-risk prostate cancer treated definitively with external-beam radiotherapy with or without androgen deprivation
Cancer 2013.