RT/hormone combo cuts PCa mortality in older men

The addition of radiation treatment to hormone therapy reduces mortality in older men with locally advanced prostate cancer compared with hormone therapy alone, according to a recently published study in the Journal of Clinical Oncology (Jan. 5, 2015).

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The authors found that hormone therapy plus radiation reduced cancer deaths by nearly 50% in men aged 76 to 85 years compared to men who only received hormone therapy.

“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. Patients and their physicians should carefully discuss curative treatment options for prostate cancer and reduce the use of hormone therapy alone,” said lead author Justin E. Bekelman, MD, of the University of Pennsylvania’s Perelman School of Medicine and Abramson Cancer Center, Philadelphia.

Two landmark clinical trials have shown that radiation plus hormone therapy yields significant improvement in survival in younger men relative to hormone therapy alone (Lancet 2009; 373:301-8 and Lancet 2011; 378:2104-11). However, there has been no comparable research on treatment in older men with advanced prostate cancer until now.

For the study, the authors examined radiation treatment and hormone therapy in the Surveillance, Epidemiology, and End Results Medicare database to compare the combination of radiation plus hormone therapy versus hormone therapy alone among 31,541 men with prostate cancer ranging in age from 65 to 85 years.

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Among men age 65 to 75 years of age, radiation plus hormone therapy was associated with a 57% reduction in prostate cancer deaths relative to hormone therapy alone (from 9.8% to 4.4% of patients at 7 years follow-up). Similarly, among men age 76 to 85 years of age, radiation plus hormone therapy was associated with a 49% reduction in prostate cancer deaths relative to hormone therapy alone (from 9.8% to 5.0% of patients at 7 years follow-up). In both groups, radiation plus hormone therapy was also associated with about one-third fewer deaths from any cause.

“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,” Dr. Bekelman said.

The research also demonstrates that the prior clinical trial findings for younger men apply in “real-world” clinical practice. Because only 3% of cancer patients participate in clinical trials, confirming that treatments work in real-world care is a crucial aspect of translating medical evidence to clinical practice, according to a University of Pennsylvania news release.

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