Hormone therapy in addition to radiation increases curability of prostate cancer

Although androgen suppression therapy (AST) has been shown to increase the risk of cardiovascular events, the survival benefit it may offer to certain patients has been unclear.  In a new study, researchers at Brigham and Women’s Hospital (BWH) have found that the addition of 6 months of AST to radiation therapy (RT) increased the overall survival rate of older men with localized, unfavourable-risk prostate cancer.  Details of this study are published in the January 23, 2008 print edition of the Journal of the American Medical Association.

“This research helps to further refine the category of men that should receive androgen suppression therapy in addition to radiation therapy to improve their chance of survival,” says Anthony D’Amico, MD, PhD, lead author and chief of Genitourinary Radiation Oncology at Dana-Farber/Brigham and Women’s Cancer Centre.

Researchers evaluated men with a median age of 72 who had unfavourable localized prostate cancer and were randomized to receive either RT alone, or AST with RT.  Researchers also subdivided the men into groups based on a comorbidity score that was determined by pre-existing medical conditions and comorbidities before randomization of therapy.  They report that in men who are otherwise healthy, the combination of RT and 6 months of AST improves curability 4-fold.  However, in men with significant health issues unrelated to cancer, especially heart disease, which was the most common comorbidity in these men, adding AST to RT could have a reverse effect, doubling the overall death rate.

“Moving forward, randomized studies should be designed to assess whether new treatments being tested are beneficial to men when other significant health issues are present.  However for now, an individual man’s health profile should be evaluated and addressed, especially when pre-existing heart disease is present, before prescribing a treatment plan involving AST,” said D’Amico.

(Source: Journal of the American Medical Association : Brigham’s and Women’s Hospital : February 2008)