According to a recent article published in The Lancet, hormonal therapy during and after radiation appears to reduce cancer recurrences and improve survival in patients with prostate cancer that has not spread to distant sites in the body.

The prostate is a walnut-sized male sex gland that is located between the bladder and rectum. The prostate is responsible for secreting a substance that forms a component of semen. Treatment options are varied for patients with prostate cancer, often depending upon the stage, or extent, of the disease. Some patients with prostate cancer that has not spread outside the prostate may be cured with radiation therapy alone. However, due to the variances in cure rates, researchers are investigating novel treatment options in order to provide consistent optimal results.

One component of therapy for prostate cancer is called hormone therapy, in which levels of male hormones, particularly testosterone, are reduced in the body. Testosterone has growth stimulatory effects on prostate cancer cells. One hormonal agent commonly used for treatment of prostate cancer that reduces the levels of testosterone in the blood is called Zoladex® (goserelin).

Previous clinical trials have suggested that radiation therapy plus hormone therapy reduces the risk of a cancer recurrence, compared to radiation therapy alone in patients with localized prostate cancer. This prompted researchers from the European Organisation for Research for the Treatment of Cancer (EORTC) to conduct a clinical trial directly comparing hormonal therapy plus radiation therapy to radiation therapy alone for prostate cancer that has not spread to distant sites in the body. This trial involved 415 men with prostate cancer, 16 of whom had cancer spread to local lymph nodes. Patients had stages II-IV prostate cancer that was considered treatable with external radiation therapy. Half of the patients were treated with radiation alone and the other half were treated with Zoladex® initiated at the beginning of radiation therapy and continued for three years.

Progression of cancer occurred in only 27 patients treated with combined therapy, compared to 90 patients treated with radiation only. Local cancer recurrences occurred in only 1.7% of patients treated with combined therapy, compared to 16.4% of patients treated with radiation only. Distant spread of cancer occurred in 9.8% of patients treated with combined therapy, compared to 29% of patients treated with radiation alone. Cancer-free survival at 5 years was 74% for patients treated with combined therapy, compared to only 40% for patients treated with radiation alone. Overall survival at 5 years was 78% for patients treated with combined therapy, compared to only 62% for patients treated with radiation alone.

The results of this clinical trial indicate that patients treated with Zoladex® during and after radiation therapy have reduced recurrences and improved survival compared to patients treated with radiation alone for the treatment of prostate cancer that has not spread to distant sites in the body. Patients who are considering radiation therapy may wish to speak with their physician about the addition of hormone therapy during and after radiation therapy or the participation in a clinical trial evaluating other novel therapies. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

Reference: Bolla M, Collette L, Blank L, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial.

The Lancet. 2002;360:103-08.

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