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Radiation Therapy prolongs life in men with
recurrent Prostate Cancer
Newswise — Men whose tumors
recur after prostate cancer surgery are
three times more likely to survive their
disease long term if they undergo
radiotherapy within two years of the
recurrence.
Surprisingly, survival
benefits were best in men whose new tumors
were growing fastest, according to results
of a “look-back” study of 635 men by Johns
Hopkins Medical Institutions researchers
reported June 18 in the Journal of the
American Medical Association.
Previous studies of radiation
therapy for recurrent prostate cancer found
that it reduced disease progression, but
this study demonstrates that it
significantly prolongs survival, as well,
according to Bruce J. Trock, Ph.D.,
associate professor of urology,
epidemiology, oncology, and environmental
health studies, and director of the Division
of Epidemiology in the Brady Urological
Institute at Johns Hopkins.
“What this new study tells us
is that even men with aggressive disease
that has recurred after surgery appear to
benefit from radiation therapy.
"It
also means that we may be able to give
radiation selectively to those who are
really likely to benefit from it,” advises
Trock.
“I found the results of this
study remarkable,” says Patrick C. Walsh,
M.D., University Distinguished Service
Professor of Urology at the Brady Urological
Institute.
“Previously, we believed that
these men -who have aggressive disease
defined by a rapid doubling of PSA in six
months or less -- had distant metastases and
would not benefit from any form of local
salvage therapy.”
PSA, or prostate specific
antigen, is the blood-based protein shed by
the organ that signals the likely presence
of cancer.
Rapid rises in PSA levels
after surgical removal of the prostate
signal the recurrence of cancer and often
convey a poor prognosis.
Approximately 30 to 40
percent of men with high-risk tumors
experience no recurrence of their cancers
after surgery and can be spared the
side-effects, that is, urinary and bowel
problems, that may come with radiation.
So, the Johns Hopkins
researchers were looking to determine
whether radiation could improve survival in
men with recurrent prostate cancer and the
optimal timing for the therapy.
In the new study, the
researchers reviewed records of 635 men who
developed recurrent cancer following radical
prostatectomy at Johns Hopkins Medical
Institutions between June 1982 and August
2004.
Of these, 397 received no
salvage radiation therapy, 160 received only
salvage radiation, and 78 received both
salvage radiation and hormonal therapy.
Median follow-up was six years after
recurrence.
Among men who had received radiotherapy for
prostate cancer recurrence, the probability
of surviving 10 years was 86 percent,
compared to 62 percent among those who did
not have radiation.
For patients with rapidly
growing tumors, defined by a PSA doubling
time of less than six months, the benefits
of salvage radiation therapy existed
regardless of Gleason score, a numerical
value that measures prostate cancer
aggressiveness.
“This review suggests that
even patients with aggressive cancer at the
time of surgery not only benefit from
salvage radiation therapy, but also actually
live longer without a second prostate cancer
recurrence,” says Theodore L. DeWeese, M.D.,
professor and chairman of the Department of
Radiation Oncology and Molecular Radiation
Sciences.
“This is the most important
news for this group of patients in a long
time.”
DeWeese suggests that
radiation oncologists and urologists now
consider salvage radiation therapy for a
broader group of patients with recurrent
prostate cancer following surgery.
In addition to Trock, Walsh
and DeWeese, the research team included
Misop Han, M.D., of the Brady Urological
Institute at Johns Hopkins; Stephen J.
Freedland, M.D., of the Surgery Section,
Durham Veterans Affairs Medical Center and
Duke Prostate Center, Departments of Surgery
and Pathology, Duke University School of
Medicine; Elizabeth B. Humphreys, M.S. of
the Brady Urological Institute at Johns
Hopkins; and Alan W. Partin, M.D., Ph.D., of
the Brady Urological Institute at Johns
Hopkins.
Funding for this study was
supported in part by the National Cancer
Institute, gifts by Dr. and Mrs. Peter S.
Bing, the Department of Defense Prostate
Cancer Research Program, and the American
Urological Association Foundation’s Astellas
Rising Star in Urology.
On the Web:
The Brady Urological
Institute at Johns Hopkins:
www.urology.jhu.edu
JAMA:
http://jama.ama-assn.org/
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