THE "NEW" PROSTATE CANCER INFOLINK

You could easily be misled by media reports on a study just published in the Journal of the American Medical Association. This study uses retrospective analysis to show that men who failed radical prostatectomy, and had a rapidly rising PSA, and got second-line radiotherapy within 2 years of failing first-line treatment, had much better long-term outcomes than men who did not receive radiotherapy.

Contrary to the way these data are being reported by the media, this is hardly surprising! Even the press release from the American Medical Association gives this paper a degree of excitment that is open to some question.

Trock and his colleagues at Johns Hopkins examined the medical records of 635 men whose cancer “returned” (i.e., they demonstrated biochemical failure and a rising PSA) after radical prostatectomy. Of these 635 men, 397 received no additional therapy, 160 received radiation therapy, and 78 had both radiation therapy and hormonal therapy. We have to assume that the 397 men who received no additional therapy met several criteria for minimal risk of subsequent metastatic disease and death from prostate cancer. This could have been because of a very slowly rising PSA level, and/or the patients’ ages at the time of disease recurrence, leading to the appreciation that their disease could subsequently be managed with hormone therapy at a later date with minimal risk of death from prostate cancer.

After a median of 6 years, the 160 men who received radiation therapy had an 86 percent chance of surviving 10 years, compared to 62 percent among those who did not have radiation. Not surprisingly at all, the men who benefited most were those whose recurrent tumors were growing the fastest.

There is a considerable body of evidence that addresses the heightened risk of patients who fail first line therapy (e.g., radical prostatectomy) and then have a rapid PSA doubling time. Such patients are well known to be at significant risk for metastatic disease. Thus, early treatment of these men with second line therapy (e.g., radiation therapy) has considerable potential to offer a survival benefit. Failure to provide such therapy to these men would probably have been unethical.

What we still do not know, however, is what the most appropriate form of second line therapy is for men in this situation: immediate radiation therapy alone, immediate radiation therapy + hormone therapy for a period of time, or immediate hormone therapy alone?

Filed under: Living with Prostate Cancer, Management, Treatment |