New research confirms that giving radiotherapy immediately after surgery to remove the prostate has long-term benefits for preventing the biochemical progression of the disease. According to the study published online first in the Lancet, it was found that after 10 years, 61% of men who received immediate radiotherapy treatment remained disease free compared with 38% who did not. “These long-term results reassure us of the continued benefit and safety of radiation therapy after prostatectomy for a large proportion of men with locally advanced or high-risk prostate cancer”, explains Michel Bolla from the Centre Hospitalier Universitaire A Michallon in France who led the research. “They also suggest that younger patients and those with positive surgical margins are most likely to benefit from immediate radiotherapy, whereas in older adults (aged 70 years plus) it could have detrimental effects.”
Worldwide, prostate cancer is the second most common cancer in men after lung cancer. One of the main treatments is removal of the prostate, but for patients whose cancer has spread beyond the prostate the risk of recurrence can be 10-50%. In many cases course of radiotherapy is often prescribed to improve outcomes.
In their study, Bolla and colleagues followed 1,005 patients with high-risk prostate cancer for more than 10 years to examine the effect of immediate postoperative radiotherapy versus watchful waiting until first signs of disease recurrence. It was also seen that even after 10 years, men given immediate radiotherapy after surgery had significantly better biochemical progression-free survival compared with those who were only monitored, with no significant difference in severe toxicity. They also had substantially better local control and so were less likely to need hormonal therapy which can have side effects after prolonged use. But in contrast to initial (5 year) results, clinical progression-free survival (where the disease has not spread to other sites) was not significantly improved with immediate radiation therapy after 10 years.