Radiation Therapy Improves Survival Benefits for Men with Recurrent Prostate Cancer – A New Study

When I returned from the conference (see yesterday’s post) I kept seeing notices and announcements from a new retrospective study out of John;s Hopkins that showed that men with prostate cancer tumors that recur after prostate cancer surgery are three times more likely to survive their disease long term if they undergo radiotherapy within two years of the recurrence! What was even more shocking was that the significant survival benefits were best when the new tumors were growing fastest. The study included a sample of 635 men.

There have been prior studies that showed radiation therapy for recurrent prostate cancer reduced disease progression, but this is the first study that demonstrates that radiation also prolongs survival.

According to Bruce J. Trock, Ph.D., associate professor of urology, epidemiology, oncology, and environmental health studies, and director of the Division of Epidemiology in the Brady Urological Institute at Johns Hopkins, “this new study tells us is that even men with aggressive disease that has recurred after surgery appear to benefit from radiation therapy. It also means that we may be able to give radiation selectively to those who are really likely to benefit from it.”

The well known doctor, Patrick C. Walsh, M.D., University Distinguished Service Professor of Urology at the Brady Urological Institute said “I found the results of this study remarkable,”. Previously, we believed that these men -who have aggressive disease defined by a rapid doubling of PSA in six months or less — had distant metastases and would not benefit from any form of local salvage therapy.”

Remember, that radiation to the prostate bed can cause significant side-effects, which may include significant urinary and bowel problems. Johns Hopkins researchers are now looking to determine the optimal timing for radiation therapy.

The study details- The researchers reviewed records of 635 men who developed recurrent cancer following radical prostatectomy at Johns Hopkins Medical Institutions between June 1982 and August 2004. Of these, 397 received no salvage radiation therapy, 160 received only salvage radiation, and 78 received both salvage radiation and hormonal therapy. Median follow-up was six years after recurrence.

Among men who had received radiotherapy for prostate cancer recurrence, the probability of surviving 10 years was 86 percent, compared to 62 percent among those who did not have radiation. For patients with rapidly growing tumors, defined by a PSA doubling time of less than six months, the benefits of salvage radiation therapy existed regardless of Gleason score.

According to Theodore L. DeWeese, M.D., professor and chairman of the Department of Radiation Oncology and Molecular Radiation Sciences at John’s Hopkins, “This is the most important news for this group of patients in a long time. This review suggests that even patients with aggressive cancer at the time of surgery not only benefit from salvage radiation therapy, but also actually live longer without a second prostate cancer recurrence.”

Your take home message- It is now clear that you discuss with your oncologists and urologists the advantages of having salvage radiation therapy for recurrent prostate cancer following surgery.

My recurrence was just two years ago and I did not have radiation therapy. At that time my oncologist recommended against it as my doubling time was less then two months and my PSA managed to climb up to 86. When I read this study I forwarded it to him and will call him in a day or two to discuss whether I should seek a radiology consult.

Journal reference:

1. Bruce J. Trock; Misop Han; Stephen J. Freedland; Elizabeth B. Humphreys; Theodore L. DeWeese; Alan W. Partin; Patrick C. Walsh. Prostate Cancer-Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy. JAMA, 2008;299(23):2760-2769