Immediate Hormonal Therapy Improves Survival In Patients With Locally Advanced Prostate Cancer
Michel Bolla, M.D., professor of radiation oncology, University Joseph Fourier Grenoble (Grenoble, France) presented a study which aimed to increase the survival of patients suffering from locally advanced prostate cancers by combining radiation with adjuvant hormone therapy administered from the start of treatment.
Prostate cancer is the second most common cancer in men. An estimated 244,000 new cases will be diagnosed in the U.S. this year; 44,000 men will die from the disease. Traditional therapy for advanced prostate cancer has involved hormonal treatment through surgical removal of the testicles (the source of male hormones) or, more recently, through the use of anti-androgen drugs. Chemotherapy has been used in patients whose tumors no longer respond to hormonal treatments, but with only limited benefit to date. Unfortunately, the long-term survival rate and clinical control of locally advanced prostate cancer are poor.
In the study, 415 patients with locally advanced prostate cancer (spread outside the prostate but confined within the pelvis) were randomized during the period of 1987-1995. At the closure of the study, 385 patients were evaluable for preliminary analysis. The median age was 71 year. One hundred ninety patients received radiotherapy alone (once a day, five days a week, for seven weeks) and 195 patients received radiotherapy plus immediate hormone therapy with the luteinizing-hormone releasing hormone (LHRH) analogue goserelin.
After a median follow-up of 33 months, five-year local control (no spread of the disease) and overall survival were significantly improved in the combined treatment group. There was a 56% survival rate among the radiotherapy group and a 78% survival rate among the combined treatment group. Seventy-five percent of the radiotherapy group achieved local control, and 95% of the combined group achieved local control.
"Although the study needs to be confirmed by a longer follow-up, these results show that external irradiation and adjuvant hormone therapy initiated at the start of treatment may provide improved disease control and survival for locally advanced prostate cancer patients," Derek Raghavan, M.D., professor and chief, Solid Tumor Oncology, Roswell Park Cancer Institute (Buffalo, NY), said at a press briefing today. "Very similar data have also been provided by the Radiation Therapy Oncology Group (RTOG) in the United States."