According to an article recently published in the Journal of Urology, the addition of initial hormone therapy to radiation therapy improves long-term survival compared to radiation therapy and delayed hormone therapy among patients with early prostate cancer that has spread to the lymph nodes.

The prostate is a walnut-sized gland that is located between the bladder and rectum in males. Standard treatment for prostate cancer is determined by the extent of spread of the cancer; a patient’s age and willingness to tolerate side effects; the aggressiveness of the cancer; and prior therapies.

Treatment options for patients whose cancer has not spread to distant sites include radiation therapy, surgery, watchful waiting (delaying treatment until disease progression), and hormone therapy. Researchers continue to compare different therapeutic approaches and associated outcomes as the optimal treatment for these patients has yet to be clearly established.

Hormone therapy-also called androgen deprivation therapy, androgen ablation, or endocrine therapy-refers to treatment that blocks the body’s formation of the male hormone testosterone. Testosterone is responsible for stimulating prostate cancer cells to grow. Hormone therapy may be achieved with drugs that block the formation of testosterone or with the surgical removal of the testicles, a procedure called an orchiectomy.

Researchers from Sweden recently reported long-term follow-up of a clinical trial comparing initial hormone therapy (orchiectomy) plus radiation therapy to radiation therapy alone in the treatment of men with prostate cancer. This trial included 91 patients with prostate cancer that had not spread to distant sites. Some patients, however, had cancer spread to nearby lymph nodes (N+). Patients were either treated with initial hormone therapy/radiation therapy or initial radiation therapy followed by hormone therapy when their cancer progressed.

  • At 14 to 19 years follow-up, 36% of patients treated with initial hormone therapy plus radiation therapy died from prostate cancer, compared with 57% of patients treated with radiation therapy only.
  • The difference in survival mainly occurred among patients whose cancer had spread to lymph nodes; there was no significant difference in survival rates between the two treatment groups among patients whose cancer did not spread to lymph nodes.

The researchers concluded that initial treatment with hormone therapy plus radiation therapy appears to improve long-term survival compared with initial radiation therapy followed by hormone therapy once the cancer progresses among patients with prostate cancer that has spread to the lymph nodes. However, it is important for all patients to discuss their individual risks and benefits of their treatment choices with their physician.

Reference: Granfors T, Modig H, Damber J, Tomic R. Long-Term Followup of a Randomized Study of Locally Advanced Prostate Cancer Treated with Combined Orchiectomy and External Radiotherapy versus Radiotherapy Alone. Journal of Urology. 2006;176:544-547.

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