Radiation Increases Survival of ADT-Treated Prostate Patients

Louis Potters, MD

The latest Lancet outlines the results of a large Phase III clinical trial that shows that men with locally advanced prostate cancer (that has not spread elsewhere) who receive radiation therapy on top of their androgen deprivation therapy (ADT) have greater overall survival compared to men on ADT alone.

Data suggests that the use of hormones without radiation therapy to manage men with high-risk prostate cancer has increased in the past several years. The results of the Warde study tell us that radiation therapy needs to be added as a component of care for these men.

Using newer technology such as intensity modulated radiation and image guidance, higher doses of radiation therapy can safely be delivered in high-risk patients. Yet using older technology and lower radiation doses than today’s standards, the authors demonstrated a remarkable 90 percent disease-specific survival for men with very high risk disease. Plus, these survival gains were achieved without any clear decrease in overall quality of life.

Based on high-level evidence, radiation therapy is saving lives of men with prostate cancer. Though other methods of treating high-risk prostate cancer exist, a radiation-based approach remains the standard against which other modalities needed to be measured. Randomized trials comparing different treatments are required to test if these other methods will be equally efficacious to radiation therapy.

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Prostate Cancer and Supplements

Louis Potters, MD, Chair of Radiation Medicine
Louis Kavoussi, MD, Chair of Urology

Prostate Cancer and Supplements

Last week, results from the SELECT Trial were released. This randomized study of 35,533 men tested the hypothesis that Vitamin E and selenium could prevent prostate cancer. Surprisingly, the results just published in the Journal of the American Medical Association not only found that the supplements had no effect on the development of prostate cancer, but also that there was a 17 percent increased incidence of cancer in men taking the supplements. Full Post - to Detail View

Prostate Treatment and Sexual Function

Louis Kavoussi, MD

An article published in this month’s Journal of the American Medical Association (JAMA) looks at factors that put men at risk for loss of erections. The authors studied the sexual function in 1,027 men who had treatment for prostate cancer and were followed for 2 years. The authors found that only 48 percent of all patients who had sexual function before treatment had erections sufficient for intercourse after treatment.

Several factors were found to result in problems. Patients with any degree of difficulty with erections prior to treatment had more difficulty afterwards. Also, older patients or those patients who had a higher PSA level (blood test that detects prostate cancer), were overweight or were Caucasian had a lower rate of recovery. In best case scenarios where men had positive risk factors (young, thin, normal function, minimal disease), sexual function was preserved 70 percent of the time. Those with poor factors only had a 10 percent rate of recovery of sexual function.

This study is important in helping physicians set expectations for patients considering any treatment for prostate cancer. Any treatment of prostate cancer, be it surgery, external beam radiation or radioactive seeds, has the potential to affect sexual function. Although the ability to be aroused and climax are not affected, loss of erections sufficient for penetration can occur. This is because nerves responsible for erections lie directly upon the prostate. So any trauma--whether manipulation during surgery or scatter of energy from irradiation--can injure the nerves and cause difficulty with erections. Even modern therapies such as nerve-sparing prostatectomy and conformal irradiation do not guarantee preservation of normal erections.

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Common Prostate Medications Linked to Increased Cancer Risk

Manish Vira, MD

Another wrench is thrown into the prostate cancer prevention, screening, and treatment conundrum.

The US Food and Drug Administration (FDA) recently released a Drug Safety Communication regarding a common class of medications called 5 alpha reductase inhibitors (5-ARI) known as finasteride and dutasteride. Two large randomized, placebo-controlled trials in which a combined 27,113 men were randomized to receive either 5-ARI or placebo to reduce the incidence of prostate cancer showed a 25 percent reduction in the incidence of prostate cancer, but also revealed a higher incidence of high-grade cancers in the cohort of men on the study drug. As a result, the FDA revised the labeling of these medications to warn of the “increased risk of being diagnosed with a more serious form of prostate cancer.”

The FDA communication further advises that:

  • 5-ARIs are not approved for the prevention of prostate cancer
  • 5-ARIs may increase the risk of high-grade prostate cancer
  • Prior to initiating therapy with 5-ARIs, healthcare professionals should perform appropriate evaluation to rule out other urological conditions, including prostate cancer, that might mimic benign prostatic hyperplasia.

It is important to understand that the FDA continues to endorse the use of 5-ARIs in the indicated treatment of men with an enlarged prostate and lower urinary tract symptoms. These medications have a proven benefit in reducing prostate volume and reducing the risk of acute urinary retention or surgery related to prostatic hypertrophy. Second, among patients being treated with 5-ARIs for prostate cancer prevention, the risk of being diagnosed with high grade cancer is very low. Full Post - to Detail View