Adding radiotherapy to hormone treatment cuts prostate cancer mortality


NEW YORK (Reuters Health), Dec 16 - Adding local radiotherapy to endocrine treatment can markedly reduce 10-year prostate cancer-specific mortality in men with locally advanced or high-risk local disease, according to a report in the December 16 online issue of The Lancet.

"In light of these data, endocrine treatment plus radiotherapy should be the new standard," lead author Dr. Anders Widmark, from Umeå University, Sweden, and colleagues conclude.

The Scandinavian Prostate Cancer Group-7 (SPCG-7) and the Swedish Association for Urological Oncology-3 trial, conducted at 47 centers in Norway, Sweden, and Denmark, involved 875 men who were randomized to receive endocrine therapy alone (three months of total androgen blockade and then continuous endocrine therapy with flutamide) or combined with radiotherapy.

During a median follow-up period of 7.6 years, 79 patients in the endocrine only group and 37 in the combination group died of prostate cancer.

The cumulative rate of prostate cancer mortality at 10 years for the endocrine only group was 23.9% compared with just 11.9% for the endocrine plus radiotherapy group. For overall mortality, the corresponding rates were 39.4% and 29.6%.

The 10-year cumulative incidence of prostate-specific antigen recurrence was also significantly higher in the endocrine only group: 74.7% versus 25.9% (p < 0.0001).

A slight trend toward more urinary, rectal, and sexual problems at five years was seen in the combination therapy group, the investigators note.

"SPCG-7 is a pivotal trial, and is the first to show an overall survival advantage for radiotherapy in the primary treatment of prostate cancer," Dr. Alex Tan and Dr. Chris Parker, from the Institute of Cancer Research, Sutton, U.K., write in an accompanying editorial.

"The results," they add, "should change current practice, making long-term hormonal therapy plus radical radiotherapy the standard of care for men with locally advanced prostate cancer."

Lancet 2008.

Last Updated: 2008-12-15 18:30:19 -0400 (Reuters Health)

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