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Fewer Weeks of Hormone Therapy Prior to Radiation Reduces Side Effects for Prostate Cancer

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Based on research presented at the American Society for Radiation Oncology's (ASTRO) 55th Annual Meeting, it was found that a shorter time period of androgen suppression therapy before radiation therapy, as opposed to a longer time period of androgen suppression therapy, leads to more preferable results and fewer detrimental side effects for intermediate-risk prostate cancer patients.

The study verified a disease-specific-survival (DSS) rate of 95 percent when patients were given fewer weeks of neoadjuvant (NEO) total androgen suppression (TAS).

The multi-institutional phase III trial, Radiation Therapy Oncology Group (RTOG) 9910, assessed 1,490 intermediate-risk prostate cancer (PCa) patients from 152 different institutions across the U.S. and Canada. radiation-prosate

Patients were amassed from 2000 to 2004 and followed for a median of 9 years, while the median age of the men was 71 at the time of accrual. The patients were ranked and randomized into two groups; group 1 comprised of 752 patients who underwent eight weeks of NEO TAS, and Group 2 comprised of 738 patients who underwent 28 weeks of NEO TAS. Both groups then underwent eight weeks of external beam radiation therapy (RT) and concurrent TAS.

Cumulative incidence was employed to calculate and test effectiveness for DSS, prostate-specific antigen (PSA) failure, locoregional tumor progression and distant metastasis. Overall survival (OS) rates were approximated via the Kaplan-Meier method and effectiveness tested with log rank. There were 30 PCa deaths in Group 1, for a 10-year DSS rate of 95 percent; and 24 PCa deaths in Group 2, for a 10-year DSS rate of 96 percent (no statistical difference).

Furthermore, there were 200 additional deaths not associated to PCa in Group 1 for a 10-year OS rate of 66 percent, and 196 of these deaths in Group 2, for a 10-year OS rate of 67 percent. By 10 years, 27 percent of patients had a PSA failure (using the newer RTOG-ASTRO definition of nadir+2), 5 percent had PCa recurrence in the prostate (locoregional) and 6 percent had distant metastasis. Hot flashes and erectile dysfunction were more prevelant in Group 2.

"Sometimes, preliminary research leads us to assume that more treatment is better, but this study serves as a strong cautionary note to put the promising treatment to the test. Overall, both groups had very, very good outcomes, but patients assigned to Group 2 had more side effects from androgen suppression than Group 1, who received only eight weeks of NEO TAS. Now, investigators know the upper boundary of how much androgen suppression is needed in this group of patients. The results have substantial importance because they can alter the research strategy to one in which investigation can now concentrate on ways to simplify the treatment and further reduce side effects, said lead author of the study and professor of radiation oncology at the Mayo Clinic in Rochester, Minn, Thomas Pisansky, MD.


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