Combo Therapy Cuts Prostate Cancer Death Rates

Study supports hormone therapy with radiation, finding no raised risk to heart

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HealthDay Reporter

THURSDAY, Jan. 3, 2008 (HealthDay News) -- New research suggests that a common but controversial treatment for prostate cancer reduces long-term death rates without greatly boosting patients' risk of heart problems, as some specialists had feared.

In patients with severe cases of prostate cancer, a combination of testosterone-lowering drugs and radiation therapy appeared to lower the odds of dying of the disease over a 10-year period, from 36 percent to 23 percent.

The treatment is only reserved for the most advanced cases of the disease, and it does have side effects. Still, the findings suggest that "if you have high-risk prostate cancer and you're going to be treated with radiation, you should probably have hormone therapy with the radiation and not do radiation by itself," said study author Dr. Mack Roach III, professor and chair of radiation oncology at the University of California, San Francisco.

Prostate cancer remains a major threat, striking an estimated one in six American men, according to the Prostate Cancer Foundation. However, prostate cancer can be treated successfully in many cases, especially when it is caught early.

In the new study, researchers looked at a combination treatment that includes drugs that lower testosterone levels in addition to radiation.

"Prostate cancer is very sensitive to [testosterone]," explained Dr. Howard Sandler, senior associate chair of radiation oncology at the University of Michigan. "It requires the presence of testosterone to grow. When the testosterone level is reduced, prostate cancer responds by dying off."

Perhaps a third to half of prostate cancer patients who undergo radiation also get the hormone treatment, Sandler said. And about 30 percent to 40 percent of all prostate cancer patients get radiation therapy, he added.

Reducing testosterone does cause side effects, such as reduced libido and hot flashes, although they're temporary. "It puts them into a kind of male menopause," Sandler said.

But there have been conflicting findings about whether the combination therapy boosts the risk of heart attacks.

In the new study, researchers looked at the effects of the treatment over the long term by examining the medical records of prostate cancer patients enrolled between 1987 and 1991. Some of the 456 patients, with an average age of 70, received radiation alone, while others got radiation plus four months of a testosterone-reduction treatment involving two drugs, goserelin and flutamide.

The study, which examined rates of health problems over 10 years of follow-up, were released online Jan. 2 in the Journal of Clinical Oncology.

Men who underwent the dual treatment instead of radiation alone did better in several areas, the researchers found. They were more likely to survive without signs of the disease (11 percent vs. 3 percent of those who had radiation alone) and more likely to avoid the spread of cancer to distant parts of the body (35 percent vs. 47 percent).

In addition, it took longer for many of those who underwent the combination treatment to develop cancer in their bones, the study found.

Researchers didn't see any statistically significant difference in the risk of fatal heart problems between the two groups.

Even if patients who undergo the combination treatment do face a higher likelihood of cardiac problems, "the risk is definitely worth the benefit," Sandler said.

More information

To learn more about prostate cancer and its treatment, visit the American Cancer Society.

SOURCES: Mack Roach III, M.D., professor and chair, radiation oncology, and professor, urology, University of California, San Francisco; Howard Sandler, M.D., senior associate chair, radiation oncology, University of Michigan, Ann Arbor; Jan. 2, 2008, Journal of Clinical Oncology online

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