New treatment could help prostate cancer patients

Death rates among high-risk prostate cancer patients can be halved by combining hormone treatment and radiotherapy, trial results have shown.

The treatment could now become standard for men with locally advanced disease who are too ill to be cured.

Potentially curative treatments for early, non-aggressive cancer include surgery to remove the prostate gland and targeted radiotherapy.

But when the tumour is starting to break out and invade surrounding tissues doctors consider that “the horse has bolted”.

In these circumstances a strategy of containment rather than cure is adopted.

Hormone, or endocrine, therapy – which stops tumours being fuelled by testosterone – is currently one of the most common ways of tackling locally advanced prostate cancer.

But new findings reported today in an early online edition of The Lancet medical journal show that survival can be dramatically improved if radiotherapy is used as well.

Researchers compared the progress of 439 men given hormone treatment alone for three months and 436 men who received the same treatment plus radiotherapy.

The men were recruited from 47 centres in Norway, Sweden and Denmark.

Over a 10-year period 23.9% of the hormone treatment-only group died compared with 11.9% of the combination treatment group.

Cancer recurrence, defined by rising levels of the blood marker prostate specific antigen (PSA), was nearly three times higher among patients only given hormone therapy.

After five years, radiotherapy was associated with slightly more frequent side effects including urinary incontinence and impotence.

The authors, led by Professor Anders Widmark, from Umea University in Sweden, concluded: “The present study indicates a significant superiority of the endocrine plus radiotherapy treatment compared with endocrine treatment alone in patients with locally advanced prostate cancer.

“The quality of life and adverse effect profile is acceptable. We therefore suggest that endocrine treatment plus radiotherapy should be the new standard of care for these patients.”

Each year more than 34,000 men in the UK are diagnosed with prostate cancer and around 10,000 die from the disease.

John Neate, chief executive of The Prostate Cancer Charity, said: “Although prostate cancer specialists will have to digest all the results of this significant study before any changes feed into medical care, it does seem to represent real progress in treatment for men with locally advanced prostate cancer – where the cancer has spread just outside the prostate gland.

“This research is about men, not mice or cells, and it gives doctors clear information on the benefit of giving a course of radiotherapy, as well as long-term hormone treatment, in men with locally advanced prostate cancers.

“The study also offers information on the possible risks. Whilst we welcome the undoubted potential progress in terms of lives saved, it is important not to dismiss the increased risk of long-term side effects on gut, bladder and sexual function.

“However, some progress in minimising the adverse effects on quality of life of combining a course of radiotherapy with hormone therapy may already be on the way.

“Current medical practice now means the dose of radiotherapy is bigger and better targeted – hitting the cancer more forcefully with less chance of damage to healthy tissues, thus reducing the risk of likely side effects.”