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
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.
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
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
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.
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
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
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 NCIs 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
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
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.
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.
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.