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Health & Medicine for Senior Citizens

Prostate Cancer Patients Live Much Longer with Hormone Therapy Added to Radiation

ADT therapy works well with intermediate grade cancer, not so well with low grade; only two grades tested in this trial

Larger graphs of prostate cancer cases and deaths 1987-2007 below story

July 15, 2011 – Adding short-term androgen deprivation therapy (ADT) to radiation therapy for men with early-stage, intermediate risk prostate cancer made a significant improvement in their overall survival after 10 years, according to a clinical trial supported by the National Cancer Institute (NCI), part of the National Institutes of Health. Benefits of the combined treatment were not seen for men with low-risk prostate cancer.

The study, the largest randomized trial of its kind, enrolled nearly 2,000 men with low-and intermediate-risk prostate cancer and followed their health status for more than nine years at 212 centers in the United States and Canada.

The results of the trial, conducted by the Radiation Therapy Oncology Group, appeared yesterday (July 14) in the New England Journal of Medicine.

From Senior Journal Archives

Androgen Deprivation Does Not Improve Survival for Seniors with Prostate Cancer

Conservative management of the disease does a better job, says 2008 study

July 8, 2008 - A therapy that involves depriving the prostate gland of the male hormone androgen does not improve survival for elderly men with localized prostate cancer, compared to conservative management of the disease, according to a study in the July 9 issue of JAMA. Which is good news for researchers at Dana-Farber Cancer Institute that released a study in February of 2007 warning this popular therapy may actually increase the risk of death from heart disease for patients over age 65. Read more...

All study participants had localized, or non-metastatic, prostate cancer and serum prostate-specific antigen (PSA) levels of less than 20 nanograms per milliliter. PSA levels of less than 20, along with normal blood tests and a normal bone scan, indicate that the cancer is low or intermediate risk.

Patients were randomly assigned to treatment with radiation alone or radiation plus short-term using drugs that drastically lowered their natural production of testosterone, a hormone which feeds prostate cancer growth.

In addition to investigating whether the participants lived longer on one therapy compared to another, the researchers also looked at whether deaths occurred due to prostate cancer or some other cause, whether the prostate cancer spread, and several other outcomes.

Study results were further analyzed on the basis of whether patients had low-risk or intermediate-risk disease. Risk was assessed using several parameters, including Gleason score (the grade of the tumor assigned by a pathologist based on an analysis of tissue samples from a biopsy), PSA level, and clinical stage of disease. Intermediate-risk men had higher Gleason, PSA, and clinical stage values than low-risk men.

 

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Medicare Bites Bullet to Cover Expensive Provenge, Prostate Cancer Drug for Bad Cases

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Cancer Statistics 2011 shows among men the reduction in lung, prostate, and colorectal cancers is nearly 80% of decline; among women, almost 60% of decrease in breast and colorectal - see chances of seniors getting cancer - June 17, 2011


 
 

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Significant improvement in overall survival

The researchers reported a statistically significant improvement in the overall survival after 10 years on the trial for participants who received the short-term ADT and radiation compared with those who received radiation therapy alone (62 percent vs. 57 percent overall survival).

Radiation therapy plus short-term ADT was also associated with fewer prostate cancer-related deaths compared to radiation therapy-alone (8 percent vs. 4 percent for the entire study population).

“This study has important significance for clinical care,” says the lead author Christopher U. Jones, M.D., Radiological Associates of Sacramento, Calif. “We now have strong scientific evidence about which patients with early-stage prostate cancer benefit from short-term ADT. This is important both for improved clinical care and the utilization of health care resources.”

Minorities well represented in study

Prostate cancer rates are higher among black men than other racial/ethnic groups. Therefore, this trial recruited nearly 400 African-American men, allowing evaluation by racial subgroups. Similar benefits from short-term ADT were seen in white and African-American populations for 10-year overall survival, disease-specific mortality, and climbing PSA levels after initially lowered levels due to ADT.

The strong minority representation in this study will permit additional in-depth analyses of the effects of these therapies in different populations in the future.

Little improvement for low-risk patients

Among men with low-risk disease, short-term ADT produced little improvement in 10-year overall or disease-specific survival. It is possible that, for patients with low-risk disease, longer follow-up is required to reveal a benefit. However, given that short-term ADT has substantial quality of life consequences, including hot flashes and higher rates of erectile dysfunction, and the 10-year disease-specific mortality in the radiation-alone arm for men with low-risk disease was 1 percent, the researchers noted that these findings do not support adding short-term ADT for low-risk prostate cancer.

Newer high-dose radiation treatments may also lessen the need for use of ADT in low-risk patients.

“This type of trial is the gold standard for proving one therapy, or combination of therapies, is more effective than another, and NCI is strongly committed to sponsoring and conducting even more of these types of trials in the future,” said Jeff Abrams, M.D. associate director of NCI’s Cancer Therapy Evaluation Program.

“Enrolling enough patients in clinical trials is always a challenge, and we owe a great deal of gratitude to the men who participated in this trial because these results will bring benefits to many men facing prostate cancer.”

Prostate Cancer Incidence and Mortality Rate Trends Since 1987

Prostate cancer is the most common cancer, other than non-melanoma skin cancer, and the second leading cause of cancer-related death in men in the United States. African American men have higher incidence and at least double the mortality rates compared with men of other racial and ethnic groups.

Prostate cancer incidence rates rose dramatically in the late 1980s when screening with the prostate-specific antigen (PSA) test, which received initial U.S. Food and Drug Administration approval in 1986, came into wide use. Since the early 1990s, prostate cancer incidence has been declining. Mortality rates for prostate cancer have also declined since the early 1990s.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families. For more information about cancer, visit the NCI Web site at www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

The National Institutes of Health (NIH), the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

What NCI Says About Prostate Cancer Treatment

Men with prostate cancer have many treatment options. The treatment that's best for one man may not be best for another. The options include active surveillance (also called watchful waiting), surgery, radiation therapy, hormone therapy, and chemotherapy. You may have a combination of treatments.

The treatment that's right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. See the section on Taking Part in Cancer Research.

Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a urologist, a surgeon who specializes in treating problems in the urinary or male sex organs. Other specialists who treat prostate cancer include urologic oncologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. For example, you may want to discuss with your doctor the possible effects on sexual activity. The NCI booklet Treatment Choices for Men with Early-Stage Prostate Cancer can tell you more about treatments and their side effects.

At any stage of the disease, supportive care is available to relieve the side effects of treatment, to control pain and other symptoms, and to help you cope with the feelings that a diagnosis of cancer can bring. You can get information about coping on the NCI Web site at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer Information Service at 1-800-4-CANCER or LiveHelp (http://www.cancer.gov/help).

>> Click here for more at NCI

>> More Prostate Cancer Clinical Trials at NCI

>> Prostate Cancer Home Page at NCI

More About Prostate Cancer

Medline Plus

The prostate is the gland below a man's bladder that produces fluid for semen. Prostate cancer is the second most common cause of death from cancer in men of all ages. It is rare in men younger than 40.

Levels of a substance called prostate specific antigen (PSA) is often high in men with prostate cancer. However, PSA can also be high with other prostate conditions. Since the PSA test became common, most prostate cancers are found before they cause symptoms. Symptoms of prostate cancer may include

   ● Problems passing urine, such as pain, difficulty starting or stopping the stream, or dribbling

   ● Low back pain

   ● Pain with ejaculation

Prostate cancer treatment often depends on the stage of the cancer. How fast the cancer grows and how different it is from surrounding tissue helps determine the stage. Treatment may include surgery, radiation therapy, chemotherapy or control of hormones that affect the cancer.

>> More at Medline Plus (links to more on prostate cancer)

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