Shorter course of treatment may provide better outcome for intermediate-risk prostate cancer

December 5, 2017
Micrograph showing prostatic acinar adenocarcinoma (the most common form of prostate cancer) Credit: Wikipedia

Prostate cancer is the most common cancer among males in the United States. Approximately, 180,000 men are diagnosed each year, and approximately 95 percent of these men have localized disease that is potentially curable. Previously, studies have consistently demonstrated that conventionally fractionated high dose external beam radiation therapy (CRT), consisting of daily treatment for two months, decreases prostate cancer recurrence, and improves metastasis-free survival. Previous studies also demonstrate that moderate hypo-fractionated radiation therapy (HRT), consisting of daily treatment for one month using a larger dose per treatment, provides a similar low risk of recurrence, and may even be lower with HRT than CRT.

To accurately test the hypothesis of a lower risk of recurrence with HRT, a new study led by investigators at Brigham and Women's Hospital published in European Urology Focus, performed a systematic review and meta-analysis, pooling available data, to assess whether an improved risk of recurrence could be demonstrated using HRT compared with CRT, in addition to assessing the relative impact of these two treatments on bladder and rectal function. Researchers found that the one-month duration HRT, was associated with a significant improvement in recurrence compared to the two-month duration CRT and therefore would be reasonable to consider in men with intermediate risk and who do not have risk factors that could predispose the patient to bladder side effects several years after the treatment is complete.

"Our results provide evidence for clinicians to consider HRT as compared with CRT as a preferred radiation treatment in men with intermediate-risk prostate and at low risk of other complications," stated Trevor Royce, MD, MPH, radiation oncologist at Brigham and Women's Hospital and first author of the study. "Treatment with a shorter course of radiation and higher doses over fewer days may be the preferred approach in appropriately selected patients with localized prostate cancer, reducing treatment time and cost to the patient, and increasing patient convenience and access to treatment."

Researchers analyzed data from over 5,000 men from three randomized studies comparing HRT with CRT in men with prostate cancer. Of the 5,484 men, 3,553 men, or 64.8 percent had intermediate-risk prostate cancer. HRT as compared with CRT was associated with a significant 13 percent reduction in the risk of recurrence. No significant difference in overall survival was found between HRT and CRT but researchers noted that the possibility exists that men in excellent health could also achieve an overall survival benefit with HRT as compared with CRT.

"Late bladder and urethra toxicities were noted to be higher in the HRT as compared to CRT group which necessitates carefully choosing men who are not at risk for sustaining a late bladder or urethral side effect," said Anthony D'Amico, MD, PhD, chief, Genitourinary Radiation Oncology at Brigham and Women's Hospital, and senior author of the study. "Men to exclude would be those who get up more than three times at night to urinate, or have urgency to urinate, or incontinence, or men who are on anti-coagulants that could increase the risk of bleeding," D'Amico said.

Researchers say further study is needed using individual patient-level data among men with high risk cancer to assess the benefit of HRT and whether toxicity, particularly those to the bladder and urinary system are also low with HRT.

Explore further: Markers for prostate cancer death can identify men in need of more aggressive treatment

More information: European Urology (2017). DOI: 10.1016/j.euf.2017.10.011

Related Stories

Markers for prostate cancer death can identify men in need of more aggressive treatment

January 12, 2017
Prostate cancer (PC) is the second leading cause of male cancer death in the United States with an estimated 26,000 deaths in 2016. Two-thirds of all PC deaths observed in the US are men with localized disease who developed ...

Study provides evidence for new approaches to prostate cancer

February 19, 2015
Monitoring prostate cancer (PC) by active surveillance (AS), with the expectation to initiate treatment if the cancer progresses, is a preferred initial option for men with low-risk PC and a life expectancy of at least 10 ...

African-American men negatively impacted by hormone therapy for treatment of prostate cancer

August 4, 2016
In a retrospective study analyzing patients' medical records, researchers at Brigham and Women's Hospital found that patients' race significantly affected their longevity by increasing the likelihood of death after receiving ...

Active surveillance preserves quality of life for prostate cancer patients

March 21, 2017
Faced with the negative quality-of-life effects from surgery and radiation treatments for prostate cancer, low risk patients may instead want to consider active surveillance with their physician, according to a study released ...

Active surveillance of intermediate-risk prostate cancer associated with decreased survival

February 24, 2015
An analysis of data on 945 patients with prostate cancer that is managed with active surveillance shows differences in outcomes depending on whether the patient was low or intermediate risk at diagnosis. Compared to patients ...

Increased radiation offers no survival benefit for patients with low-risk prostate cancer

July 16, 2015
Increased radiation dose is associated with higher survival rates in men with medium- and high-risk prostate cancer, but not men with low-risk prostate cancer, according to a new study from Penn Medicine published this week ...

Recommended for you

Drug suppresses spread of breast cancer caused by stem-like cells

December 12, 2017
Rare stem-like tumor cells play a critical role in the spread of breast cancer, but a vulnerability in the pathway that powers them offers a strategy to target these cells using existing drugs before metastatic disease occurs, ...

MRI scans predict patients' ability to fight the spread of cancer

December 12, 2017
A simple, non-invasive procedure that can indicate how long patients with cancer that has spread to the brain might survive and whether they are likely to respond to immunotherapy has been developed by researchers in Liverpool.

Insights on how SHARPIN promotes cancer progression

December 11, 2017
Researchers at Sanford Burnham Prebys Medical Discovery (SBP) and the Technion in Israel have found a new role for the SHARPIN protein. In addition to being one of three proteins in the linear ubiquitin chain assembly complex ...

Glioblastoma survival mechanism reveals new therapeutic target

December 11, 2017
A Northwestern Medicine study, published in the journal Cancer Cell, has provided new insights into a mechanism of tumor survival in glioblastoma and demonstrated that inhibiting the process could enhance the effects of radiation ...

A new weapon against bone metastasis? Team develops antibody to fight cancer

December 11, 2017
In the ongoing battle between cancer and modern medicine, some therapeutic agents, while effective, can bring undesirable or even dangerous side effects. "Chemo saves lives and improves survival, but it could work much better ...

Liver cancer: Lipid synthesis promotes tumor formation

December 11, 2017
Lipids comprise an optimal energy source and an important cell component. Researchers from the Biozentrum of the University of Basel and from the University of Geneva have now discovered that the protein mTOR stimulates the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.