SAN FRANCISCO, CA USA (UroToday.com) - Dr. Fosså presented updated results from the Scandinavian Prostate Cancer Group 7 (SPCG 7) randomized controlled trial of lifelong hormone treatment alone or combined with radiotherapy.
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When the results of this trial were first reported at 7.6 years of follow-up, men with locally advanced or advanced (based on histological criteria) prostate cancer treated with 3 months of total androgen blockade followed by radiotherapy and continuous anti-androgen therapy were associated with a 12% reduction in prostate cancer specific mortality compared to hormone treatment alone. The authors presented updated 10- and 15-year survival results after a median observation period of 10. 7 years.
Patients included in the trial were < 75 years old, had a PSA < 70, T3 (80% of patients) or T1/2 grade 2/3 disease, “good” performance status, and cN0 disease (all patients with PSA > 10 underwent PLND). Patients randomized to combination therapy received 70-75Gy pelvic EBRT and lifelong anti-androgen therapy. Prostate cancer specific death occurred in 26.9% and 10.3% of patients treated with anti-androgen monotherapy and combination therapy, respectively (p < 0.001) (death due to any cause: 47.8% and 36.9%, respectively). Ten-year prostate cancer-specific mortality was 8.3% for patients treated with combined therapy compared to 18.9% for monotherapy. Fifteen-year prostate cancer-specific mortality was also improved for patients treated with combination therapy (12.4% vs. 30.7%). Similar results favoring combined therapy were reported for overall mortality at 10 (26.4% vs 35.3%) and 15 (43.4% vs 56.7%) years.
At 4 years of follow-up, there was no impact of combination treatment on global quality of life. A post-randomization prostate biopsy study revealed recurrent or persistent disease in 66% vs 12% of patients treated with anti-androgen therapy alone or combined therapy, respectively. Dr. Fosså reported that these data are comparable to large recently published series of radical prostatectomy, however a head-to-head comparison of RP and combined therapy should be defined in randomized trials. Among men with locally advanced or high-risk prostate cancer, the addition of radiotherapy to androgen blockade more than halves prostate cancer-specific and overall mortality. The author’s recommend combined therapy be considered a standard curative treatment option.
Highlights of a presentation by Sophie D. Fosså, MD, PhD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
The Norwegian Radium Hospital, Oslo, Norway
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com