Low mortality rate for men at high risk of death from prostate cancer who received postoperative radiation therapy

In a large international retrospective study, men at high risk of death from prostate cancer had a significant reduction in all-cause mortality if treated with radiation shortly after surgery.

Prostate cancer it is one of the most common forms of cancer among men and approximately 1 in 8 people will be diagnosed during their lifetime. Although most men are cured with the treatment available, they remain a group with a high risk of death. In the United States in 2020, 33,330 men died from the disease prostate cancer the second leading cause of cancer death in men in this country. Therefore, among those at increased risk of recurrence, metastasis, and death by prostate cancer, understanding what measures can be taken to reduce these risks can save and prolong life.

First results of three random, clinical trials did not report any benefit in donating adjuvant radiation therapy (that is, when the prostate specific antigen (PSA) cannot be measured) instead of early recovery radiotherapy (i.e., when the PSA level becomes measurable, the signal recurrence). But these three studies had a very small number of men at high risk of death from prostate cancer. A new retrospective study focuses on men who have high-grade prostate cancer that spreads outside the prostate and / or has spread to the lymph nodes. For these men at high risk of dying from the disease, there was a significant reduction in the risk of death with the use of adjuvant radiotherapy (ATR), suggesting that it should be offered to these men. The results are published in The Journal of Clinical Oncology.

“We found that men at higher risk of dying from prostate cancer may miss the opportunity to be cured if we expect PSA to be measured before providing radiation after surgery,” said author Anthony D ‘Amico, MD, Ph.D., professor and head of oncology of genitourinary radiation at Brigham and Women Hospital and the Dana-Farber Cancer Institute. “Although three previous randomized studies have largely encompassed men with a very low risk of dying from prostate cancer after surgery, men with a high risk of dying from prostate cancer have more to lose by delaying pregnancy. “use of early and potentially life-saving radiation therapy. We focused on these patients and the sentinel endpoint of mortality.”

To conduct their study, D’Amico and colleagues took advantage of a cohort of more than 26,000 men treated between 1989 and 2016 in the United States and Germany. The cohort included 2,424 patients who had a high risk of dying from prostate cancer despite surgery: men with a Gleason score of 8-10 and an extension of the cancer beyond the prostate capsule and / or pelvic lymph nodes.

The researchers found that adjuvant radiation therapy was associated with significantly lower all-cause mortality. Among men with high-grade prostate cancer that spread outside the prostate, the risk of death was reduced by two-thirds. Ten years after radical prostatectomy, the all-cause mortality rate was 5% among those receiving adjuvant radiotherapy, compared with 22% of those receiving sRT. Among which the cancer had spread to the lymph nodes, a group that many consider incurable, the risk of death was reduced by a third.

The authors point out that their study is retrospective in nature, and while they took many steps to adjust and control relevant patient-cancer-related factors, there may be some degree of selection bias. For example, men selected as adjuvant compared to early sRT could have been healthier. Therefore, it is possible that the reduction in risk in death may overestimate the true reduction in risk.

“For those men at high risk of dying from prostate cancer despite surgery, adjuvant radiation therapy instead of waiting until the PSA is measured seems to be able to reduce mortality from all causes,” D ‘said. Friend. “If we want to have a global impact on reducing the number of people dying from prostate cancer, it’s important to look at what can be done to help these men who are most at risk of dying from this disease.”