Prostate cancer recurrence: radiotherapy combined with hormone therapy

Patients with recurrence of prostate cancer benefit from a combination of radiotherapy and hormone therapy. This was confirmed by an American multi-centre study recently published in the renowned specialist magazine "New England Journal of Medicine". 

If the PSA level rises again permanently after radiotherapy or surgical removal of the prostate, this is often a sign that the tumour is growing again. More than a quarter of the patients after radical prostatectomy or radiotherapy suffer a relapse (recurrence). If no metastases are present, radiation treatment, known as "salvage" - radiation therapy as brachytherapy or external radiation therapy, can achieve a cure for about half of the men,"explains Dr. Stephan Neubauer, urologist at the West German Prostate Center (WPZ) in Cologne. 

HDR-Brachytherapy after prostate cancer relapse

The prostate specialists from Cologne are achieving good results in patients with a local recurrence with a highly specialized form of radiotherapy, the so-called afterloading procedure (HDR brachytherapy). A radiation source with a high dose rate is brought directly into the prostate gland in order to destroy tumor cells that are growing again in a targeted manner. After-loading therapy can be performed as a "salvage" treatment after previous surgery as well as after radiotherapy or brachytherapy,"explains the Cologne expert. Advantages over radical surgery as "salvage" therapy are, in addition to equivalent success rates measured by the PSA value (biochemical control), above all a better quality of life with fewer side effects.

Survival benefit from combined hormone therapy

The question of whether treatment with hormones in addition to radiation therapy has an advantage for the men affected was investigated by American scientists in a long-term study, the results of which have recently been published in the New England Journal of Medi-cine. A total of 760 patients from 130 different centres were examined, who suffered a relapse after surgical removal of the prostate gland but were free of metastases. Half of these men were randomly given radiotherapy alone, while the other half received a combination of radiotherapy and two-year hormone treatment with the anti-androgen biculamide.

The study results clearly demonstrate the positive benefit of an additional hormone therapy on survival prospects: For example, the annual overall survival rate after an observation period of 12 years in the hormone-treated group was 76 percent, compared to 71 percent in the group of men who received radiation therapy alone. The risk of metastasis formation was also significantly lower with the addition of biculamide at 14.5 percent compared with 32 percent. With regard to the frequency of late damage caused by radiation, there was no difference between the two groups. However, as expected, hormone-treated men were more likely to experience breast augmentation (gynecomastia) as a side effect of anti-androgen therapy.

The West German Prostate Center also relies in many cases on the combined treatment of prostate cancer recurrence:"With hormone treatment, which we carry out in addition to salvage radiation therapy, we can significantly improve the chances of recovery or survival and reduce the risk of metastasis formation in other organs," summarizes Dr. Neubauer. 

Literature:

Shipley. W. U. et al.: Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer, New England Journal of Medicine 2017;376:417-428

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