The results of a study on prostate cancer published in the current issue of the New England Journal of Medicine "suggests use of hormone therapy is important when giving radiation to men with high risk prostate cancer features," said area urologist Alexander Berry.
HOLYOKE - The results of a study on prostate cancer published in the current issue of the New England Journal of Medicine "suggests use of hormone therapy is important when giving radiation to men with high risk prostate cancer features," said urologist Alexander Berry.
The study, which bolsters information on prolonging life in treating prostate cancer as a chronic disease in some men, focused on the addition of hormone control therapy in treating patients who had surgery, as well as radiation, for high risk prostate cancer that showed evidence for recurrence.
"We have known for 20 years that the addition of hormone therapy to radiation for the primary treatment of prostate cancer is better than radiation alone in patients with high risk prostate cancer features," said Berry who is with Holyoke Medical Center's Urology Center.
Dr. Alexander BerryRepublican file
"This study helps show that this also applies in the setting when radiation is used as a secondary treatment following prostate surgery."
In short, Berry said the "study helps confirm what we suspected. Patients who have high risk prostate cancer benefit from combined therapy with hormones and radiation versus radiation alone."
The study, funded by the National Cancer institute, was led by Dr. William U. Shipley, a radiation oncologist at Boston's Massachusetts General Hospital.
Conducted from 1998 through 2004, it followed 760 eligible patients who, in addition to radiation post surgery, were either given drugs for a period of 24 months to block testosterone to help kill off any existing cancer cells or slow their growth, or a placebo. The male hormone testosterone helps prostate cancer cells grow.
According to the study, the patients given the hormone control therapy had "higher rates of long-term overall survival and lower incidences of metastatic prostate cancer and death from prostate cancer than radiation therapy plus placebo."
Berry noted that some treatment changes for patients with high risk prostate cancer have already been made since the study was conducted. He said one of these includes giving such patients radiation before there is evidence of rising PSA.
PSA, or prostate-specific antigen, is a protein produced by cells of the prostate gland. Elevated levels of PSA in the blood can be indicative of a number of conditions, including prostate cancer, considered a slow growing cancer in that part of the male reproductive system involved with the creation of semen.
"Because prostate cancer is relatively slow moving studies take 10 to 15 years before final data is often collected. In the meantime certain ideas may have already changed," Berry said.
He added that patients in the study had prostate surgery and were "known to be at higher risk of prostate cancer recurrence because the prostate cancer at the time of surgery had been found to be just outside the prostate but within the surgical margin." However, until there was evidence of rising PSA (which can be produced by cancerous cells as well), he said patients in the study, on average, "had a gap of 2.1 years between surgery and the start of radiation."
"Over the past two to three years there has been growing evidence that patients with prostate cancer that is found outside the prostate but within the surgical margin at the time of surgery do better if they have radiation to the pelvis before the PSA is found to rise. This is normally three to six months after surgery to let things heal," Berry said.
"In addition other studies have shown that six months of hormone blockade in this scenario may be better than no hormones."
Barry added that there have been changes in the last 20 years to "what type of hormone therapy is preferable" as well as when radiation should be started and that such "changes would be expected to have additional benefit regarding overall survival."
He noted the study spanned two decades as the researchers "were looking for evidence of better overall survival between the groups."
"In the group who received the hormones and the radiation there was a lower chance they died from prostate cancer and a lower chance the prostate cancer became metastatic," Berry noted. However, he called "the impact of hormones on the overall survival" a finding from the study that "needs to be considered."
"At 12 years, 76 percent of men with hormones and radiation were still alive vs 71 percent of men who did not receive hormones," Berry said.
"It appears that adding hormones might reduce your chance of death from prostate cancer, but it might increase your chance from dying from something else. This is something we have see before with people who are on hormone therapy and are still exploring."
Berry said hormone therapy is something he regularly uses with his high risk patients, but said "there are downsides to using hormones."
"Hormones are a form of medical castration and as such there are potential negative side effects that should be considered. These include hot flashes, weight gain, potential mood changes, bone weakness and cardiac events. There is some suggestion that for men over 65 with moderate to severe cardiac disease the risk of fatal cardiac events outweighs the benefit from hormonal therapy," Berry said.
He noted that the "majority of prostate cancers that are detected are low risk."
"These respond very well to a number of different available treatments with low failure rates, including observation," Berry said.
He called high risk prostate cancer "a different story" and one that "can be difficult to manage" even when caught early.
"Unfortunately the course of prostate cancer is uncertain. We know that high risk prostate cancer has a higher rate of progression. In these cases the most important indicator is how soon treatment fails. If the PSA does not stay low, but climbs back up within two years of any initial therapy this is a strong indicator for more aggressive disease," Berry said.
Berry added that "there are plenty of men living with advanced prostate cancer that appears to be relatively slow moving."
"I try to tell my patients that managing prostate cancer is more like running a marathon than a sprint. Most of the time we think about long-term, ongoing management. Overall I would say that it is not the case that prostate cancer becomes more aggressive in later stages," Berry said.
"What tends to happen is that a man diagnosed with aggressive prostate cancer - meaning a cancer that fails to respond to initial treatment - is far more likely to progress to advanced disease than a man with low risk prostate cancer. Luckily aggressive forms of prostate cancer are far less common than other forms of prostate cancer."
Berry said, "These ideas about low risk prostate cancer and aggressive prostate cancer are the main reasons behind the confusion around PSA screening for prostate cancer."
"In an ideal world doctors would have a way to screen for aggressive prostate cancer and intervene in such a way to change the patients outcome. Unfortunately, screening everybody for elevated PSA does not help achieve this," Berry said.
"The American Urology Association suggests PSA measurement in men with a higher risk of prostate cancer. This would include men who have a father or brother who were diagnosed with prostate cancer at a younger age, as well as African American men and those with an elevated PSA at baseline. If I could encourage anything it would be for men to get a baseline PSA at 45 and 50 years of age and then make an informed decision moving forward regarding further PSA testing."