Improving Results in High-Risk Prostate Cancer with Radiotherapy

Prostate cancer is the most widely recognized cancer among males in the United States. Approximately, 180,000 men are diagnosed every year, and around 95 percent of these men have localized disease that is potentially treatable.

Previously, studies have consistently shown that conventionally fractionated high dosage external beam radiation treatment (CRT), consisting of daily therapy for two months, reduces prostate cancer recurrence, and improves metastasis-free survival. Previous researchers likewise show that moderate hypo-fractionated radiation therapy (HRT), consisting of daily therapy for one month utilizing a larger dosage per treatment, gives a comparatively low risk of recurrence, and may even lower with HRT than CRT.

To accurately test the hypothesis of a lower risk of recurrence with HRT, a new examination led by researchers at Brigham and Women’s Hospital published in European Urology Focus, performed a systematic review and meta-analysis, pooling available information, to assess whether an improved risk of recurrence could be shown utilizing HRT compared and CRT, addition to evaluating the relative effectiveness of these two treatments on bladder and rectal function.

Researchers observed significant improvement in recurrence with HRT for one-month duration, when compared with the two-month span CRT and therefore would be reasonable to consider in men with intermediate-risk prostate cancer and who don’t have risk factors that could incline the patient to bladder side effects several years after the treatment is finished.

Trevor Royce, MD, MPH, the radiation oncologist at Brigham and Women’s Hospital and first author of the study stated, “Our outcomes give evidence to clinicians to consider HRT as compared and CRT as a preferred radiation treatment in men with intermediate-risk prostate cancer and at low risk of other complications.

Treatment with a shorter course of radiation and higher dosages over fewer days might be the preferred approach in appropriately selected patients with localized prostate cancer, decreasing treatment time and cost to the patient, and increasing patient convenience and access to treatment.”

Scientists analyzed information from more than 5,000 men from three randomized examinations comparing HRT and CRT in men with prostate cancer. Of the 5,484 men, 3,553 men, or 64.8 percent had intermediate-risk prostate cancer. HRT, as compared with CRT, was related to a significant 13 percent decrease in the risk of recurrence. No significant difference in overall survival was found amongst HRT and CRT but Scientists noticed that the possibility exists that men in excellent health could likewise achieve an overall survival advantage with HRT as compared with CRT.

Anthony D’Amico, MD, PhD, chief, Genitourinary Radiation Oncology at Brigham and Women’s Hospital, and senior author of the study said, “Late bladder and urethra toxicities were noted to be higher in the HRT when compared with CRT group which requires carefully choosing men who are not at risk of sustaining a late bladder or urethral side effect”.

D’Amico said, “Men to prohibit would be the individuals who get up more than three times around night time to urinate, or have an urgency to urinate, or incontinence, or men who are on anti-coagulants that could increase the risk of bleeding”.

Scientists say additionally further study is required utilizing individual patient-level data among men with high-risk prostate cancer to assess the advantage of HRT and whether treatment toxicity, especially those to the bladder and urinary system are also low with HRT.

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