Among men who have undergone prostatectomy for locally advanced prostate cancer (prostate cancer that has spread to nearby tissues), post-surgery radiation therapy reduces the likelihood of PSA increase and cancer recurrence but does not appear to significantly affect risk of distant metastases or overall survival. These results were published in the Journal of the American Medical Association.
Other than skin cancer, prostate cancer is the most commonly diagnosed form of cancer among males in the United States. The prostate is a walnut-sized gland that is located between the bladder and the rectum. It is responsible for forming a part of semen.
Locally advanced prostate cancer refers to cancer that has spread from the prostate to nearby tissues, but not to lymph nodes or distant sites in the body. Standard treatment for locally advanced prostate cancer may include surgery, radiation therapy, and/or hormone therapy.
Because the benefits of post-surgery radiation therapy are still uncertain among men with locally advanced prostate cancer, researchers conducted a clinical trial among 425 men. After prostatectomy, study subjects were assigned to receive either radiation therapy or observation and usual care.
The primary goal of the study was to determine whether radiation therapy reduced the risk of distant metastases. The researchers also collected information about prostate-specific antigen (PSA) levels, cancer recurrence, and overall survival. Half the study subjects have now been followed for more than 10 years.
- There was no significant difference between study groups in risk of distant metastases or overall survival.
- Men who received radiation therapy were less likely than men in the comparison group to experience a post-treatment PSA increase. A PSA increase occurred in 35% of the men treated with radiation therapy and 64% of the men in the comparison group.
- Cancer recurrence was also less common in the men treated with radiation therapy.
- Men treated with radiation therapy were more likely to develop problems such as proctitis or rectal bleeding, urethral strictures, and urinary incontinence.
The researchers conclude that although post-surgery radiation therapy may decrease the likelihood of PSA increase and cancer recurrence among men with locally advanced prostate cancer, it does not appear to have a significant effect on risk of distant metastases or survival, and increases the risk of rectal and urinary problems. This information may be valuable to patients and physicians as they consider treatment options.
Reference: Thompson IM, Tangen CM, Paradelo J et al. Adjuvant Radiotherapy for Pathologically Advanced Prostate Cancer: A Randomized Clinical Trial. JAMA. 2006;296:2329-2335.
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