MedWire News: Adding local radiotherapy to endocrine treatment halves the 10-year prostate cancer-specific mortality in patients with locally advanced or high-risk local prostate cancer compared with endocrine treatment alone, researchers report.
“In the light of these data, endocrine treatment plus radiotherapy should be the new standard,” Anders Widmark (Umeå University, Sweden) and team write in The Lancet.
Both endocrine therapy and radiotherapy have been used to treat prostate cancer, and several studies have shown the efficacy of endocrine therapy in combination with radiotherapy in high-risk prostate cancer, the authors explain.
Widmark and team undertook a phase III study to investigate the effect of combining the two approaches, randomly assigning 875 patients with locally advanced prostate cancer to receive either endocrine treatment alone (3 months of total androgen blockade followed by continuous endocrine treatment; n=439), or combined with radiotherapy (n=436).
After a median follow-up of 7.6 years, 79 men in the endocrine alone group and 37 men in the endocrine plus radiotherapy group had died of prostate cancer, the researchers report.
The cumulative incidence at 10 years for prostate cancer-specific mortality was halved by the addition of radiotherapy, with a mortality rate of 23·9% in the endocrine alone group compared with 11·9% in the endocrine plus radiotherapy group.
In addition, the 10-year cumulative incidence for overall mortality was 39·4% in the endocrine alone group and 29·6% in the endocrine plus radiotherapy group.
The cumulative incidence at 10 years for PSA recurrence was also substantially higher in men in the endocrine-alone group, at 74·7% versus 25·9% in the combined treatment group.
“Compared with endocrine treatment alone, the addition of definitive prostate radiotherapy reduces the 10-year cancer-specific and overall mortality by 12·0% and 9·8%, respectively, in non-metastatic prostate cancer patients with locally advanced tumors or tumors that are prostate-confined but with aggressive histology,” the authors write.
In an accompanying comment article, Alex Tan and Chris Parker, from the Institute of Cancer Research in Sutton, Surrey, UK, described the study as “pivotal,” saying that it was the “first to show an overall survival advantage for radiotherapy in the primary treatment of prostate cancer.”
They concluded: “The results should change current practice, making long-term hormonal therapy plus radical radiotherapy the standard of care for men with locally advanced prostate cancer.”
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