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The addition of radiation therapy to antiandrogen therapy halved the 10- and 15-year rates for mortality among men with high-risk nonmetastatic prostate cancer compared with hormone therapy alone, according to updated study results presented at the 2014 Genitourinary Cancers Symposium.
“In 1996, lifelong castration treatment was viewed as standard treatment for patients with locally advanced or high-risk prostate cancer without metastasis in Scandinavia, Europe and also in the United States,” Sophie Dorothea Fosså, MD, a professor in the department of oncology at Oslo University Hospital in Norway, said during a press conference. “Most of these patients were viewed at that time as inoperable. At the same time, we had data that showed anti-androgens resulted in fewer side effects than castration treatment without having a negative impact on survival. Therefore, the primary aim of our trial was to have at least a 10% reduction of the 10-year prostate cancer specific mortality by adding local radiation therapy to hormone treatment.”
Sophie Dorothea Fosså
From 1996 to 2002, Fosså and colleagues assigned 875 men with locally advanced or histologically aggressive prostate cancer to total androgen blockade followed by radiation therapy or continuous antiandrogen therapy alone for 3 months.
The researchers used death registry data for Norwegian patients and the Case Report Form database for Swedish patients to conduct an extended analysis after a median observation time of 10.7 years.
More prostate cancer-related deaths occurred among patients assigned antiandrogen therapy alone (118 of 439) than antiandrogen therapy plus radiation therapy (45 of 436; P˂.0001).
More men assigned antiandrogen therapy alone also died from any cause (210 vs. 161; P=.0006).
Researchers determined the prostate cancer-specific mortality rate was more than twice as high among patients assigned to hormone therapy alone at 10 years (18.9% vs. 8.3%) and 15 years (30.7% vs. 12.4%).
“When this study started in 1996, the standard treatment was hormone therapy alone, but this trial continues to show that adding radiotherapy substantially boosts long-term survival,” Fosså said in a press release. “This combination more than doubles the 10-year survival rate and confirms that this approach should be a standard option for men with this type of prostate cancer who are expected to live at least another 10 years.”