Radiation Plus Androgen-Deprivation Therapy Prolongs Survival for Older Men With Prostate Cancer
Adding radiation treatment to androgen-deprivation therapy saves more lives among older men with locally advanced prostate therapy than androgen-deprivation therapy alone, according to a new study reported by Bekelman et al in the Journal of Clinical Oncology.
The researchers found that androgen-deprivation therapy plus radiation reduced cancer deaths by nearly 50% in men aged 76 to 85 compared to men who only received androgen-deprivation therapy. Past studies have shown that 40% of men with aggressive prostate cancers are treated with androgen-deprivation therapy alone, exposing a large gap in curative cancer care among baby boomers aging into their 70s.
“Failure to use effective treatments for older patients with cancer is a health-care quality concern in the United States. Radiation plus hormone therapy is such a treatment for men with aggressive prostate cancers,” said lead author Justin E. Bekelman, MD, Assistant Professor of Radiation Oncology, Medical Ethics, and Health Policy at the University of Pennsylvania’s Perelman School of Medicine and Abramson Cancer Center. “Patients and their physicians should carefully discuss curative treatment options for prostate cancer and reduce the use of hormone therapy alone.”
Two landmark clinical trials have shown that radiation plus androgen-deprivation therapy produces a large and significant improvement in survival in younger men relative to androgen-deprivation therapy alone, but until now, there has been no comparable research on treatment for older men with advanced prostate cancer.
Study Details
The current study compared the combination of radiation plus androgen-deprivation therapy vs androgen-deprivation therapy alone among 31,541 men with prostate cancer aged 65 to 85 years of age in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients received treatments not by random assignment but as part of their normal clinical care. The investigators utilized specialized analysis techniques to mimic randomized clinical trials in data from routine care and to identify which treatments are best for men of different age groups and cancer severity.
Among men aged 65 to 75 years old, radiation plus androgen-deprivation therapy was associated with a reduction in prostate cancer deaths of 57% relative to androgen-deprivation therapy alone (from 9.8% to 4.4% of patients at 7 years follow-up). Similarly, among men aged 76 to 85 years old, radiation plus androgen-deprivation therapy was associated with a reduction in prostate cancer deaths of 49% relative to androgen-deprivation therapy alone (from 9.8% to 5.0% of patients at 7 years follow-up). In both groups, radiation plus androgen-deprivation therapy was also associated with about one-third fewer deaths from any cause.
Importantly, the clinical trials have shown that the side effects of radiation plus androgen-deprivation therapy are very acceptable relative to androgen-deprivation therapy alone. “Older men with aggressive prostate cancers should know that the combination of radiation plus hormone therapy is both tolerable and effective in curing prostate cancer,” said Dr. Bekelman.
In addition to offering new evidence for older men, the study demonstrates that the prior clinical trial findings for younger men apply in the “real world” of routine clinical practice. Only 3% of cancer patients participate in clinical trials; thus, confirming that treatments work in real-world care is a crucial aspect of translating medical evidence to clinical practice.
Dr. Bekelman is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Cancer Institute, the National Institutes of Health, and the American Cancer Society. Elizabeth A. Handorf, PhD, reported research funding from Pfizer. Robert G. Uzzo, MD, reported serving on speakers’ bureaus for Pfizer and Janssen.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
