Recent reviews, reports and research relating to radiotherapy for prostate cancer

"When it comes to radiotherapy for prostate cancer, more may be better" - article by Anna Azvolinsky - CancerNetwork Oncology 7 March 2014. Read the web article here or here:

Irradiation Produces Durable Survival in Prostate Cancer
. Author: Roxanne Nelson. In a 5 March 2013 article in Medscape Urology News here Roxanne Nelson reports on a research study by F A Critz et al. That study was initially reported inOctober 2012 - see the abstract here: Nelson's article includes this commentary: "In prostate cancer, radiation therapy and radical prostatectomy produce 'durable disease control.' In fact, 15-year disease-free survival rates with the 2 treatments are similar, according to a new study published in the March issue of the Journal of Urology…However, the researchers found that prostate cancer can recur after many years. Therefore, they recommend that patients be followed for at least 15 years after their initial treatment…'Some physicians feel that after 10 years, you don't have to continue follow-up, but we found that 5% of recurrences happen after 10 years,' explained lead author Frank A. Critz, MD, founder and medical director of Radiotherapy Clinics of Georgia. 'We've seen some recurrences after 15 years, and we have 1 patient with disease recurrence after 17 years,' he noted…On the basis of their study, Dr. Critz believes that follow-up should be at least 15 years, 'but personally, I think 20 years if preferable.... If the PSA is below 0.2 ng/mL at 20 years, then the PSA checks can be discontinued.' 'After 20 years, we have not seen a recurrence,' he noted." It should be noted that the comparisons made with radical prostatectomy are not based on data collected by the researchers but reflect 15-year recurrence rates observed in two other studies that were reported in 2002 and 2005.

Radiotherapy in the Management of Prostate Cancer After Radical Prostatectomy. In a detailed and technical 2013 Medscape Urology News article by Detlef Bartkowiak et al, radiotherapy options subsequent to a radical prostatectomy are reviewed and evaluated. An abstract by the authors is as follows: "The choice of treatment options for prostate cancer patients who have undergone radical prostatectomy depends on their risk profile, which is determined by the tumor node metastasis (TNM) status, histopathologic findings, and the pre- and post-radical prostatectomy PSA characteristics. The results of large clinical studies with a 10-year follow-up or more are the backbone of predictive models for risk estimates that incorporate these criteria and also for guideline recommendations. For low-to-intermediate-risk prostate cancer patients and older patients, observation with – in case of biochemical recurrence – early salvage radiotherapy can be advised after R0 resection, thus, avoiding overtreatment. After R1 resection, adjuvant radiotherapy should be considered. Patients with two or more positive lymph nodes and/or with distant metastasis may benefit from adjuvant hormone deprivation therapy. Beyond this rough outline, detailed analysis of subgroups is still required (and ongoing) to enable individually optimized treatment." The full article can be read here: Note: "R0" resection indicates complete removal of all tumor with microscopic examination of margins showing no tumor cells. "R1" resection indicates that the margins of the resected parts show tumor cells when viewed microscopically.

Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911).
Author: Michel Bolla et al. The Lancet, Volume 380, Issue 9858, Pages 2018 - 2027, 8 December 2012 doi:10.1016/S0140-6736(12)61253-7 Extract from the article: Background: We report the long-term results of a trial of immediate postoperative irradiation versus a wait-and-see policy in patients with prostate cancer extending beyond the prostate, to confirm whether previously reported progression-free survival was sustained. Interpretation: Results at median follow-up of 10·6 years show that conventional postoperative irradiation significantly improves biochemical progression-free survival and local control compared with a wait-and-see policy, supporting results at 5 year follow-up; however, improvements in clinical progression-free survival were not maintained. Exploratory analyses suggest that postoperative irradiation might improve clinical progression-free survival in patients younger than 70 years and in those with positive surgical margins, but could have a detrimental effect in patients aged 70 years or older. Web link:

Article by Schieszer J: Should radiation therapy plus hormone therapy be the new standard of care for locally advanced prostate cancer? Oncology News International Vol. 19 No. 9 September 2, 2010. The author claims that while Androgen Deprivation Therapy (ADT) has become the primary treatment for men with locally advanced prostate cancer, emerging data suggest that ADT alone is not as effective as ADT plus External-beam Radiation Therapy (EBRT) and that recently, international researchers claim their data are strong enough to make continuous ADT plus EBRT the new standard of care. Viewable and downloadable as a 156 KB PDF file here.  

Salvage External Beam Radiotherapy for Prostate Cancer After Radical Prostatectomy. Article in Oncology Vol 24 No. 1 July 2010. Authors: Radlow, A et al. A copy is downloadable as a 209 KB PDF file from here. The authors indicate that: “The treatment of prostate cancer that has recurred months or years after radical prostatectomy is an evolving field, and multiple consensus guidelines and prognostic features exist to help the clinician make a decision regarding treatment fields and likelihood of efficacy. Though there are multiple randomized trials supporting the use of ART (Adjuvant Radiation Therapy) in the immediate post-prostatectomy period for high-risk disease, similarly strong data are lacking in the salvage setting. However, the rate of serious complications has been low in patients undergoing SRT (Salvage Radio Therapy) , and there are multiple retrospective studies showing a subset of patients who are likely to benefit. Although there have been no studies that address the specific question of whether SRT is cost-effective, extrapolating on available data, we believe that SRT is cost-effective in selected patients who are likely to benefit based on MRI findings of local disease or the Stephenson nomogram.” (The Stephenson nomogram referred in the article is here and is implemented as one of the Sloan Kettering nomogram predictive tools.)