Study on hormone therapy and radiation

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Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 3/26/2011 7:33 PM (GMT -6)   
Is this a new study? old news?
It was emailed me today.


www.businessweek.com/lifestyle/content/healthday/651221.html

Short Course of Hormone Therapy Boosts Prostate Cancer Survival: Study
Coupled with radiation, six months of treatment improved odds in locally advanced cases, researchers found

By Steven Reinberg
HealthDay Reporter
HealthDay/ScoutNews LLC

THURSDAY, March 24 (HealthDay News) -- Just six months of hormone therapy, along with radiation, cuts the risk of dying from locally advanced prostate cancer in half when compared to radiation alone, researchers report.

Just as important, the study indicates that a short course of hormone therapy has few of the side effects seen with longer treatment regimens of two to three years.

Hormone therapy in men, also known as androgen-deprivation therapy, lowers levels of the male hormones that encourage prostate cancer to grow.

"A halving of the risk of dying from these more advanced prostate cancers clearly has very major significance for men affected," said researcher Dr. David Lamb, director of the Prostate Cancer Trials Unit at the University of Otago in Wellington, New Zealand.

"Early diagnosis of prostate cancer remains the goal, but at least men presenting with more advanced tumors can now be offered treatment proven to have a much better chance of cure," he said.

The report is published in the March 24 online edition of The Lancet Oncology.

As part of the Trans-Tasman Radiation Oncology Group trial, Lamb's group randomly assigned 802 men with locally advanced prostate cancer to radiation alone, or three months of hormone therapy plus radiation, or six months of hormone therapy and radiation.

Over an average of 10.6 years of follow-up, men who received six months of hormone therapy and radiation were significantly less likely to die from prostate cancer than men who had radiation alone -- 11 percent vs. 22 percent, respectively. They were also much less likely to die from any cause -- 29 percent vs. 43 percent, the researchers found.

Hormone therapy over three months had no effect on the spread of prostate cancer, or dying from the cancer or any other cause, compared with radiation alone, Lamb's team noted.

Compared to a six-month bout of the hormone therapy, androgen-deprivation therapy over an extended period can result in serious side effects, including erectile dysfunction, hot flashes, fatigue, osteoporosis, high cholesterol, anemia and cardiac death.

"This study with locally advanced prostate cancers has shown that adding [just] six months of hormone treatment to radiotherapy halves the numbers of deaths from prostate cancer in the next 10 years," Lamb said.

"Whilst there were already known to be benefits from short-term hormone treatment in this group of patients, this is the first trial to demonstrate the magnitude of long-term benefits. A 50 percent improvement in survival is a massive gain, and it was achieved with relatively few extra side effects for patients," he added.

Prostate cancer expert Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said this study validates his own research, which showed that six months of hormone therapy plus radiation prolonged survival.

"You get an overall survival benefit when you add six months of hormone therapy to radiation in men with high-risk prostate cancer," he said. "Six months of hormonal therapy with radiation is a valid treatment option with high-risk prostate cancer."

Men may choose to have longer hormone treatment, D'Amico said. However, survival will probably only marginally improve, and there is a risk for heart problems with the prolonged use of hormone therapy, he said.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/26/2011 7:40 PM (GMT -6)   
Of course, they are talking about HT being added to RT as a primary treatment, not as in being added to SRT. Seems like doctors are evenly divided in their sharp opinions on this subject, which makes it even harder for a patient to know what best to do in my opinion,

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 3/26/2011 10:16 PM (GMT -6)   
I LIKE that 6 months is enough idea..

deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 250
   Posted 3/27/2011 9:02 AM (GMT -6)   
I would like to know more about , , what the thought is on HT and SRT combined ,what the outcome is ?
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1 surgery path report Gleason 3+4=7 poorly differentiated tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3 perineural invasion present high grade of PIN found T2c NX MX PSA 0706 .01 10/06 .02 01/07 .03 04/07 .04 06/07 .05 07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscint

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 3/27/2011 9:14 AM (GMT -6)   
I don't want to know since I've already elected SRT without HT.
 
One set of SE is enough, thank you very much.
 
Mel

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 3/27/2011 11:34 PM (GMT -6)   
I get Google news email upades on all things "prostate", so needless to say I have been getting a ton of updates on this study from the various reporting media.

Having just finished SRT myself, it also concerned that my dr might have suggested HT as well had this study been posted then.

Can anybody clarify any of this for me???:

*If this was primary treatment, how did they identify all 800+ as "locally advanced"?

*I believe at the 10.6 year point, more died from other causes than pca, so what was the median age of those in the test?

*802 patients, and none of them were advised to have surgery instead?

*All were locally advanced at time of the study, so one would naturally expect that there would be a higher number of cancers having spread past the protate bed, rendering radiation alone insufficient.. So should it surprise us that more of those who didnt get HT therapy would die?

I dunno, I think they needed to clarify some of the data before coming to the conclusions. I mean, do these results mean that having HT a year before, or a year after, would not produce the same results?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 3/28/2011 12:32 PM (GMT -6)   
Bob,
I'll try to answer some of your questions.
Most doctors are not up to date on the latest studies. Most are still using what they learned in Med School or from studies that are years old. Unless they specialize in only prostate cancer it is very unlikely that they are as up to date as many men on the forum. A urologist sees many patients for all sorts of different conditions; PC is a small part of most practices. I saw a urologist last year for an unrelated condition, We talked a bit about my PC and it was readily apparent that his knowledge of PC was cursery at best. I found the same with 4 out of the 5 urologists I visisted during my DX stage. Within 10 minutes of my meeting with a specialist dealing only in PC did I even realize the lack of depth of my other 5 doctors. That's when I realized that I would have to learn much more on my own in order to be successful in this fight.
Locally advanced was most likely developed from a scan or using stats that the Partin tables incicated a high probability of local advancement. In this case surgery would not have been an option.
I was lucky in that my specialist insisted on HT in conjunction with my treatments; I'm certain that none of my other doctors would have recommended it or even mentioned it.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/28/2011 1:05 PM (GMT -6)   
Bob,
The patients had to clearly diagnosed as locally advanced and not as suggested by tables but rather defined as follows:

"All 818 patients had to be initially diagnosed with locally advanced prostate cancer (i.e., clinical stages T2bN0M0, T2cN0M0, T3N0M0, or T4N0M0".

The T2 andT4 stuff would be easier to define that the T3 guys but it can be done with biopsy and some imaging. It is my own assumption that guys that were not in fact verified to be in these stages they were eliminated from the study.

Here is the InfoLink post and the actual paper on the study...

prostatecancerinfolink.net/2011/03/25/6-months-of-neoadjuvant-adt-doubles-survival-when-given-with-radiation-therapy/

This is very strong Level 1 evidence with definable end points.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino
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