Prostate cancer survival improved with whole-pelvic radiation plus hormone therapy

Patients with localized prostate cancer who have a 15% estimated risk of lymph node involvement and an elevated prostate-specific antigen level are good candidates for whole-pelvic radiotherapy plus neoadjuvant and concurrent hormonal therapy.

These are the findings of a phase III study involving 1323 such patients reported by Dr. Mack Roach III of the University of California in San Francisco and colleagues in the May 15th issue of the Journal of Clinical Oncology.”This trial tested the hypothesis that combined androgen suppression and whole-pelvic radiotherapy followed by a boost to the prostate improves progression-free survival by 10% compared with combined androgen suppression and prostate only prostate-only radiotherapy,” they explain. “This trial also tested the hypothesis that neoadjuvant and concurrent hormonal therapy improves progression-free survival compared with adjuvant hormonal therapy adjuvant hormonal therapy by 10%,” they further explain.According to the team, whole-pelvic radiotherapy was associated with a 4-year progression-free survival of 54% compared with 47% for prostate-only radiotherapy (p = 0.022). Patients treated with neoadjuvant and concurrent hormonal therapy had a 4-year progression-free survival of 52% versus 49% for adjuvant hormonal therapy (p = 0.56).Compared with the other treatment, the combination of whole-pelvic radiotherapy plus neoadjuvant and concurrent hormonal therapy was associated with the longest progression-free survival (60%).”This study proves that there is a favorable biologic interaction between whole-pelvic radiotherapy and neoadjuvant and concurrent hormonal therapy, but no advantage to short-term neoadjuvant and concurrent hormonal therapy compared with short-term adjuvant hormonal therapy when only the prostate is irradiated,” the investigators conclude.The benefits of whole-pelvic radiotherapy plus neoadjuvant and concurrent hormonal therapy in the lymph nodes “should not be completely surprising,” they add. “Occult lymph node involvement despite negative imaging is a well-recognized problem in patients with prostate cancer, and prophylactic nodal radiotherapy has been shown to prolong survival in women with breast cancer,” they add.(Source: J Clin Oncol 2003;21:1904-1911: Reuters Health: June 13, 2003: Oncolink)