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If prostate cancer comes back after surgery, adding hormone therapy to radiation helps

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JimJimJimJim

Jim Marshall (not a doctor) said ...

Sometimes prostate cancer comes back after a prostatectomy.

If it does come back (we say it recurs) doctors will often recommend radiotherapy.

 

But would adding hormone therapy to the radiotherapy do any good?

 

This trial tested whether hormone therapy would make a difference.

 

Half the men in the trial got real hormone therapy pills. Half got pills that looked the same, but weren't real hormone therapy pills (placebo). They all took the pills for 2 years.

 

After following the men for around 13 years they found:

Men on the hormone therapy:

  • lived longer;
  • had fewer cases of metastatic spread; and
  • were less likely to die of prostate cancer.

 

The hormone therapy was Bicalutamide (brand names Casodex, Cosudex) at 150mg per day. 

... end Jim

 

N Engl J Med. 2017 Feb 2;376(5):417-428. doi: 10.1056/NEJMoa1607529.

Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer.

Shipley WU1, Seiferheld W1, Lukka HR1, Major PP1, Heney NM1, Grignon DJ1, Sartor O1, Patel MP1, Bahary JP1, Zietman AL1, Pisansky TM1, Zeitzer KL1, Lawton CA1, Feng FY1, Lovett RD1, Balogh AG1, Souhami L1, Rosenthal SA1, Kerlin KJ1, Dignam JJ1, Pugh SL1, Sandler HM1; NRG Oncology RTOG.

Author information

 

Abstract

Background Salvage radiation therapy is often necessary in men who have undergone radical prostatectomy and have evidence of prostate-cancer recurrence signaled by a persistently or recurrently elevated prostate-specific antigen (PSA) level. Whether antiandrogen therapy with radiation therapy will further improve cancer control and prolong overall survival is unknown. Methods In a double-blind, placebo-controlled trial conducted from 1998 through 2003, we assigned 760 eligible patients who had undergone prostatectomy with a lymphadenectomy and had disease, as assessed on pathological testing, with a tumor stage of T2 (confined to the prostate but with a positive surgical margin) or T3 (with histologic extension beyond the prostatic capsule), no nodal involvement, and a detectable PSA level of 0.2 to 4.0 ng per milliliter to undergo radiation therapy and receive either antiandrogen therapy (24 months of bicalutamide at a dose of 150 mg daily) or daily placebo tablets during and after radiation therapy. The primary end point was the rate of overall survival. Results The median follow-up among the surviving patients was 13 years. The actuarial rate of overall survival at 12 years was 76.3% in the bicalutamide group, as compared with 71.3% in the placebo group (hazard ratio for death, 0.77; 95% confidence interval, 0.59 to 0.99; P=0.04). The 12-year incidence of death from prostate cancer, as assessed by means of central review, was 5.8% in the bicalutamide group, as compared with 13.4% in the placebo group (P<0.001). The cumulative incidence of metastatic prostate cancer at 12 years was 14.5% in the bicalutamide group, as compared with 23.0% in the placebo group (P=0.005). The incidence of late adverse events associated with radiation therapy was similar in the two groups. Gynecomastia was recorded in 69.7% of the patients in the bicalutamide group, as compared with 10.9% of those in the placebo group (P<0.001). Conclusions The addition of 24 months of antiandrogen therapy with daily bicalutamide to salvage radiation therapy resulted in significantly higher rates of long-term overall survival and lower incidences of metastatic prostate cancer and death from prostate cancer than radiation therapy plus placebo. (Funded by the National Cancer Institute and AstraZeneca; RTOG 9601 ClinicalTrials.gov number, NCT00002874 .).

 

Comment in

Improved Therapy for PSA Recurrence after Prostatectomy. [N Engl J Med. 2017]

PMID: 28146658 

[Highlighting by JM]

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