Endocrine therapy plus radiotherapy superior treatment in advanced or high-risk prostate cancer

Posted January 20, 2009
Endocrine therapy plus radiotherapy superior treatment in advanced or high-risk prostate cancer

Adding radiotherapy to endocrine treatment reduced 10-year prostate cancer–specific mortality in half among patients with locally advanced or high-risk local prostate cancer, according to data from an open phase-3 study (SPCG-7/SFUO-3).
The study included men from 47 centers in Denmark, Norway and Sweden. Eight hundred seventy-five men with locally advanced prostate cancer were randomly assigned to endocrine treatment alone or endocrine treatment plus radiotherapy. Prostate cancer–specific survival was the primary endpoint.

Prostate cancer caused death in 79 men in the endocrine therapy alone group and 37 men in the endocrine therapy plus radiotherapy group after a median follow-up of 7.6 years. At 10 years, the cumulative incidence for prostate cancer–specific mortality was 23.9% in the endocrine therapy group and 11.9% in the endocrine plus radiotherapy group, yielding an RR of 0.44 (95% CI, 0.30-0.66).
The cumulative incidence for overall mortality after 10 years was also lower in the endocrine plus radiotherapy group compared with the endocrine therapy alone group (29.6% vs. 39.4%).

After 10 years, the cumulative incidence for PSA recurrence was higher in patients in the endocrine therapy group (74.7%) vs. the endocrine therapy plus radiotherapy group (25.9%; HR=0.16; 95% CI, 0.12-0.20). However, patients in the endocrine therapy plus radiotherapy group experienced more urinary, rectal and sexual problems after five years than patients in the endocrine therapy alone group.
“In light of these data, endocrine treatment plus radiotherapy should be the new standard,” the researchers wrote. – by Stacey L. Adams
Lancet. 2008;doi:10.1016/S0140-6736(08)61815-2.

This is the first randomized trial to demonstrate that radical radiotherapy improves the survival of men with locally advanced prostate cancer. The new data will likely have little effect on clinical practice in the United States because most such patients were already receiving radiotherapy. However, in other parts of the world it has until now been a standard practice to treat men with locally advanced disease with hormone therapy alone. In the future, long-term HT should be used in combination with radical radiotherapy.
– Chris Parker, MD, MRCP, FRCR
Academic Urology Unit, Institute of Cancer Research,
Royal Marsden Hospital, Sutton, England