Radiation Therapy Prolongs Life in Men with Recurrent Cancer
Bruce J. Trock It is a question that dogs every man who undergoes surgery for prostate cancer. Even in the best possible conditions, even if the odds are extremely unlikely, this niggling thought is there. What will I do if my cancer comes back?
There is good news: Radiation therapy.
“ This is the most important
news for this group of patients
in a long time.”
A new study, published in the Journal of the American Medical Association, and led by Bruce J. Trock, Ph.D., the Carolyn and Bill Stutt Scholar, shows that carefully selected men in this situation are more likely to experience prolonged survival if they undergo “salvage” radiation therapy within two years of the recurrence.
“We were surprised to find that the men who did the best were those whose tumors were growing the fastest,” says Trock, Director of the Brady’s Division of Epidemiology. “Although we knew, from other research, that salvage radiotherapy decreased the progression of disease, this is the first study to show that it significantly prolongs survival — even in men with aggressive disease. It also means that we may be able to give radiation selectively to those who are really likely to benefit from it.”
“I found the results of this study remarkable,” said Patrick C. Walsh, M.D., University Distinguished Service Professor of Urology. “Previously, we believed that these men –who have aggressive disease defined by a rapid doubling of PSASA in six months or less — had distant metastases and would not benefit from any form of local salvage therapy.”
The scientists reviewed records of 635 men who developed recurrent cancer following radical prostatectomy at Hopkins between June 1982 and August 2004. Of these, 397 did not receive salvage radiation therapy, 160 received only salvage radiation, and 78 received both salvage radiation and hormonal therapy. The average follow-up was six years.
Among men who had received salvage radiotherapy, the likelihood of surviving 10 years was 86 percent, compared to 62 percent for those who did not have radiation. Men with particularly aggressive tumors (defined by a PSASA doubling time of less than six months) were helped by salvage radiation therapy, regardless of their Gleason score. The survival benefit, however, was limited to men whose PSASA decreased to an undetectablelevel after the radiation, “This review suggests that even patients with aggressive cancer at the time of surgery may not only benefit from salvage radiation therapy, but also actually live longer without a second prostate cancer recurrence,” said Theodore L. DeWeese, M.D., Chairman of the Department of Radiation Oncology and Molecular Radiation Sciences. “This is the most important news for this group of patients in a long time.”