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Some pelvic lymph nodes shown here in green. – Illustration credit Sam Webster |
In a clinical trial that could change standard practice, researchers at Cedars-Sinai Cancer Center in Los Angeles led by Howard Sandler, MD, chair of the Department of Radiation Oncology, reported that prostate cancer patients who had radiation therapy to the area of the removed prostate, androgen deprivation therapy, and pelvic lymph node radiation had a median five-year survival of 87 percent.
That compared to 71 percent of men who underwent standard radiation to the prostate area after removal of the prostate, and to the 81 percent 5-year survival of a third group that had received a combination of androgen deprivation therapy in addition to radiation therapy to the area of the removed prostate.
“We can now confirm that pelvic lymph node treatment used together with androgen deprivation therapy, or even used as a stand-alone treatment option, greatly improves outcomes in patients with postoperative prostate cancer,” Sandler said in a press release. “These findings are an encouraging step forward, both for the medical community and for the patients and their loved ones seeking curative treatment options.”
The clinical trial conducted at 283 cancer centers in the US, Canada, and Israel involved 1,792 men who had undergone surgery to remove the prostate and had persistently detectable PSA or had initially undetectable PSA that had risen to between 0.1 and 0.2. PSA measures the level of a protein produced by the prostate in the blood. After surgery to remove the prostate that level should be near zero. When the PSA rises years after surgery it is an indication that further radiation therapy is needed.
The men in the trial were randomly assigned to three different treatment regimens. Group 1 received radiation to the area of the removed prostate. Group 2 received that same radiation plus androgen deprivation therapy, a treatment that suppresses levels of certain hormones, including testosterone that stimulate cancer growth. The third group received the standard radiation plus radiation therapy to the lymph nodes in the pelvic region and androgen deprivation therapy.
After five years 1,716 participants could be analyzed, and 71 percent of the men in Group 1 had a median progression-free survival of 5 years. Half had longer progression-free survival and half had less than five years. In Group 2, 81 percent survived progression free and in Group 3, 87 percent remained progression free for 5 years.
The researchers concluded that adding short-term hormone suppression to radiation therapy to the prostate bed and the lymph nodes results in meaningful reductions in disease progression after prostatectomy.
Sources: Cedars Sinai press release and the journal The Lancet
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