There were many very interesting and very important items presented at the recent ASCO GU conference. Over the course of the next week or two I will be systematically reviewing many of these finds that have a direct impact on men with advanced prostate cancer.

Today’s review is about how to create better results for men with locally advanced or high-risk prostate cancer. Researchers found that adding a treatment course of local radiotherapy to hormonal treatment (ADT) in men with locally advanced or high-risk prostate cancer more than halved the 10-year and 15-year prostate-cancer–specific mortality compared to treatment with anti-androgens (ADT) alone. These results come from a updated analysis of the Scandinavian Prostate Cancer Group VII study.

According to Sophie Dorothea Fosså, MD, a professor in the department of oncology at Oslo University Hospital in Norway, “In these patients the combination of radiotherapy and hormones may be considered as a standard curative treatment option and patients should be informed about this.” She also said “This updated data showed that at 10 years, cumulative prostate-cancer–specific mortality was 8.3% in patients assigned combination treatment compared with 18.9% in the anti-androgen alone arm; at 15 years, it was 12.4% compared with 30.7% in the anti-androgen alone arm.”

In 2009, the Scandinavian Prostate Cancer Group presented results from this study showing a 12% reduction of prostate cancer specific mortality in patients on combined treatment after a median follow-up of 7.6 years. In these updated results, Fosså provided the 10-year and 15-year prostate-cancer–specific survival after a median observation of 10.7 years.

In the trial which went from 1996 to 2002, there was 875 men enrolled who were younger than 75 years. All the men came from Norway, Sweden, and Denmark.

All men received 3 months of total androgen blockade and were then randomly assigned to endocrine treatment with the anti-androgen flutamide alone (n = 439) or combined with radiotherapy (n = 436).

According to the final study results, men assigned to combined treatment had an almost 11% reduction in absolute risk for prostate cancer specific mortality at 10 years, and an 18% reduction at 15 years. There were 118 prostate cancer specific deaths in the anti-androgen alone arm compared with 45 in the combination arm.

“Of course the difference was less for the overall mortality though still significant,” Fosså said. “As we know many patients die of other disease other than prostate cancer.”

In addition to the significant reduction in prostate cancer– pecific mortality seen with the combined treatment, overall mortality was also reduced in the combination arm at both 10 years (35.3% vs. 26.4%) and 15 years (56.7% vs. 43.4%).

Men experienced long-term adverse effects concerning urinary, bowel, and sexual functions. The events were more pronounced in the combination arm than in the endocrine treatment alone arm. However, after 4 years, the researchers found no effect of the combination treatment on global quality of life.

This trial has some weaknesses for those of us in the Western Hemisphere where Flutamide is not the standard of care in ADT. However, the results should still be seriously considered in conversation with your doctor as they probably translate into well into the style of ADT used in the Western Hemisphere.

We also want to disagree with the language used by Dr.
Fosså when she indicated that this method of combined therapy might provide a cure for prostate cancer. There is no evidence that this treatment, or any other provide the potential of a cure. We continue to discourage this language.

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Joel T. Nowak, M.A., M.S.W.