Localized prostate cancer patients may benefit from hormone suppression combined with radiation treatment

Localized prostate cancer patients may benefit from hormone suppression combined with radiation treatment

While a man with localized prostate cancer will live longer if he receives male hormone suppression therapy combined with radiation treatment, the same does not happen for patients with moderate/high levels of other illnesses, says an article in the Journal of the American Medical Association (JAMA), January 23rd issue.

The authors explain that prior studies have shown that patients with unfavorable localized and locally advanced prostate cancer who receive androgen suppression therapy (AST) together with RT (external radiation therapy) survive for longer than those who receive RT alone. However, patients who have co-existing illnesses may have increased negative side-effects to such a degree that their survival advantages are not there.

Anthony V. D'Amico, M.D., Ph.D., Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, and team carried out an analysis of overall survival of 206 patients with localized but unfavorable-risk prostate cancer in subgroups defined by their level of co-existing illnesses at the time of their randomization to AST combined with RT vs. RT alone. 74 of them died during a follow-up period of 7.6 years.

Overall survival estimates were significantly higher for those patients who randomly received RT combined with AST, compared to the men who just received RT, the authors report. "The cumulative incidence estimates of prostate cancer-specific mortality significantly favored the RT and AST group, with an increased risk of prostate cancer-specific mortality (14 vs. 4 deaths) that translated into an increased risk of all-cause mortality (44 vs. 30 deaths) in men randomized to RT compared with RT and AST."

The researchers observed a substantial interaction between comorbidity score and treatment. For the 157 patients with no or very low comorbidity scores there was a significantly higher survival rate for those receiving combination treatment compared to those who just received RT (31 vs. 11 deaths). However, among the 49 patients with moderate/severe comorbidity, those receiving RT alone did not have a higher all-cause mortality rate than those receiving RT combined with AST (13 vs. 19 deaths).

The researchers wrote "The clinical significance of this finding is that pre-existing comorbid illness may increase the negative effects of specific anti-cancer treatments such as AST," the authors write. In conclusion, the addition of 6 months of AST to RT resulted in increased overall survival in men with localized but unfavorable-risk prostate cancer. This result may pertain only to men without moderate or severe comorbidity, but this requires further assessment in a clinical trial specifically designed to assess this interaction."

"Androgen Suppression and Radiation vs Radiation Alone for Prostate Cancer - A Randomized Trial"

Anthony V. D'Amico, MD, PhD; Ming-Hui Chen, PhD; Andrew A. Renshaw, MD; Marian Loffredo, RN, OCN; Philip W. Kantoff, MD

JAMA. 2008;299(3):289-295.

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