Palliative prostate-specific radiotherapy in men with advanced prostate cancer

It is still not unusual, in large parts of the world, for patients to be diagnosed with prostate cancer and treated with hormone therapy as a first-line treatment or following a period of active surveillance or monitoring — for all sorts of reasons.

Such patients may go on to have a spectrum of localized prostatic symptoms associated with their cancer. Examples of the type of symptom we are referring to include urinary tract obstruction, hematuria (blood in the urine), pelvic pain, and rectal symptoms. A report by Din et al. now offers data on outcomes from the clinical application of short-course palliative radiotherapy to the prostate as treatment for such localized symptoms at a single British institution.

Relevant information about how the study was carried out is as follows:

  • 58 patients, all treated between 2003 and 2007, were identified from hospital radiotherapy records.
  • All patients had advanced prostate carcinoma.
  • Data on patients’ demographics, radiotherapy details, and responses were collected retrospectively.
  • Symptoms and toxicity were scored, retrospectively, according to the following scale:
    • 0 = no symptoms
    • 1 = mild symptoms
    • 2 = moderate symptoms
    • 3 = severe symptoms

Study results are provided below:

  • The median age at radiotherapy was 76.6 years (range: 54 to 91).
  • 56/58 patients (97 patients) had hormone refractory disease.
  • 27/58 patients (47 percent) had evidence of metastatic disease.
  • The most common radiation dose schedule was a total of 20 Gy delivered in 5 fractions.
  • The most frequent baseline symptom was hematuria (in 31/58 patinets, 54 percent).
  • Of the 35 patients for whom response data were available, 31 (89 percent) reported complete or partial resolution of symptoms at 4 months.
  • Response rates for individual symptoms (including unknown responses) were:
    • Rectal symptoms = 75 percent
    • Pelvic pain  = 69 percent
    • Urinary obstruction= 54 percent
    • Haematuria = 42 percent
  • A reduction in PSA level of > 50 percent occurred in 5 patients.
  • Toxicities were mild to moderate and were self-limiting.

The authors conclude that palliative radiotherapy to the prostate gland as treatment for local symptoms appears to be an effective means of palliation with minimal toxic side effects. They suggest that prospective clinical trial be conducted to assess the potential benefits of such treatment in greater detail.

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