Prostatectomy and Radiation More Effective for Locally Advanced Prostate Cancer
Among men with prostate cancer that has extended beyond the outer covering of the prostate, those who receive radiation therapy immediately after their prostatectomy survive longer without a worsening of their cancer than those who are treated with prostatectomy alone, according to a study published in The Lancet.
The prostate is a gland of the male reproductive system that is responsible for producing some of the fluid that transports the sperm during ejaculation. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men. Patients diagnosed with locally advanced prostate cancer (prostate cancer that has extended outside of the prostate, without spread to lymph nodes or distant sites) must choose between treatment with radiation therapy, surgery (radical prostatectomy), participation in a clinical study or “watchful waiting” in selected circumstances. Unfortunately, there have been few well-controlled clinical studies comparing these treatment approaches.
To determine whether prostatectomy followed immediately by radiation therapy offers better treatment results than prostatectomy alone for men with locally advanced prostate cancer, researchers in Europe conducted a randomized clinical trial that directly compared these two treatments in 1005 men. All men enrolled in the clinical trial had either prostate cancer that extended beyond the outer covering of the prostate (T3) or surgical results suggesting that not all of the cancer had been removed (positive surgical margin). None of the men had cancer that had spread to lymph nodes or distant sites in the body. All men were treated with prostatectomy, and half the men received additional treatment with radiation therapy within 16 weeks of their surgery (immediate radiation therapy). In the group of men that received treatment with prostatectomy alone, subsequent treatment (most often with radiation therapy) was provided if there was evidence that the cancer progressed.
Approximately five years from treatment, the men treated with the combination of prostatectomy and immediate radiation therapy were more likely to survive without a worsening of their cancer than men treated with prostatectomy alone. Currently, 74% of the men in the combined treatment group are alive without a worsening of their cancer compared to only 53% of men treated with prostatectomy alone. Many of the men in the radiation therapy group experienced adverse effects of radiation, such as diarrhea or frequent or painful urination, but severe adverse effects were rare.
The researchers conclude that immediate radiation therapy after prostatectomy in men with positive surgical margins or cancer that has spread beyond the outer covering of the prostate survive longer without a worsening of their cancer than men who are treated with prostatectomy alone. Longer follow-up is necessary to determine whether immediate radiation therapy reduces the probability of distant spread of the cancer and improves overall survival.
Reference: Bolla M, van Poppel H, Collette L et al. Postoperative radiotherapy after radical prostatectomy: a randomized controlled trial (EORTC trial 22911). The Lancet. 2005.366:572-78.
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