Trimodal treatment success for high-risk prostate cancer patients
MedWire News: High-risk prostate cancer patients have a significantly reduced risk for prostate cancer-specific mortality (PCSM) if brachytherapy (BRT) is supplemented with androgen suppression therapy (AST) and external-beam radiation therapy (EBRT), research findings suggest.
Despite a higher baseline probability of death from the disease, high-risk patients (defined as those with stage T3 or T4 cancer, a prostate-specific (PSA) antigen level above 20 ng/ml or a Gleason score between 8 and 10) had their PCSM risk reduced by 68% when treated with BRT in conjunction with AST and EBRT compared with BRT alone.
“These data should heighten awareness among physicians that, to maximize curability in men with high-risk prostate cancer treated using BRT, the addition of both supplemental AST and EBRT seems necessary,” say Anthony d’Amico, from Brigham and Women’s hospital in Boston, Massachusetts, USA, and colleagues.
The study comprised 1342 men with high-risk prostate cancer who were observed over a minimum period of 2 years, during which time no patient died.
Participants were treated with BRT alone, with supplemental AST, EBRT, or both, and PCSM risk was estimated after taking into account age, year of treatment, and known prostate cancer prognostic factors.
While supplementing BRT with AST and EBRT proved superior to BRT alone for reducing PCSM risk, men treated with either supplementary AST or EBRT reduced their PCM risk by a nonsignificant 37% and 43%, respectively.
Indeed, there was a near-significant 47% reduction in PCSM risk with trimodal compared with bimodal therapy.
The findings highlight that BRT alone is a suboptimal treatment for men with high-risk prostate cancer, the researchers note.
“The addition of AST to EBRT enhances the radiation therapy cell killing effect, making sterilization of macroscopic extracapsular extension possible and thereby improving local control,” they explain.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
By Sarah Guy