Radiation plus hormone therapy prolongs survival for older men with prostate cancer
Adding radiation treatment to hormone therapy saves more lives among older men with locally advanced prostate cancer than hormone therapy alone, according to a new study in the Journal of Clinical Oncology (2015; doi:10.1200/JCO.2014.57.2743).
The researchers found that hormone therapy plus radiation reduced cancer deaths by nearly 50% in men ages 76 to 85 years compared to men who only received hormone therapy. Past studies have shown that 40% of men with aggressive prostate cancers are treated with hormone therapy alone, exposing a large gap in curative cancer care among baby boomers aging into their 70s.
"Failure to use effective treatments for older patients with cancer is a health care quality concern in the United States. Radiation plus hormone therapy is such a treatment for men with aggressive prostate cancers," said lead author Justin E. Bekelman, MD, an assistant professor of Radiation Oncology, Medical Ethics and Health Policy at Penn's Perelman School of Medicine and Abramson Cancer Center in Philadelphia, Pennsylvania.
"Patients and their physicians should carefully discuss curative treatment options for prostate cancer and reduce the use of hormone therapy alone."
Locally advanced prostate cancer is cancer that has spread outside but near the prostate gland. Unlike slower growing tumors, locally advanced prostate cancer is an aggressive malignancy prone to metastasis and cancer death. Hormone therapy lowers or blocks the levels of testosterone and other androgens that feed prostate cancer tumors.
Two landmark clinical trials have shown that radiation plus hormone therapy produces a large and significant improvement in survival in younger men relative to hormone therapy alone, but until now there has been no comparable research on treatment for older men with advanced prostate cancer.
Addressing this question for the first time, Penn's research team compared the combination of radiation plus hormone therapy versus hormone therapy alone among 31,541 men with prostate cancer ranging in age from 65 years to 85 years.
Among men ages 65 to 75 years, radiation plus hormone therapy was associated with a reduction in prostate cancer deaths of 57% relative to hormone therapy alone (from 9.8% to 4.4% of patients at 7 years follow-up).
Similarly, among men ages 76 to 85 years, radiation plus hormone therapy was associated with a reduction in prostate cancer deaths of 49% relative to hormone therapy alone (from 9.8% to 5.0% of patients at 7 years follow-up). In both groups, radiation plus hormone therapy was also associated with approximately one-third fewer deaths from any cause.
Importantly, the clinical trials have shown that the side effects of radiation plus hormone therapy are very acceptable relative to hormone therapy alone.
In addition to offering new evidence for older men, Bekelman's research also demonstrates that the prior clinical trial findings for younger men apply in the real world of routine clinical practice. Only 3% of cancer patients participate in clinical trials; thus, confirming that treatments work in real-world care is a crucial aspect of translating medical evidence to clinical practice.