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High-Dose Radiation Reduces Prostate Cancer Recurrence

Breaking News - September 2005 - Week 4

(Sep 28, 2005)

Healthcare in  the News

-- High-dose radiation can cut prostate cancer recurrence by half, but it has no impact on survival rates, according to a study reported in the Journal of the American Medical Association (JAMA).

A picture of a man, reading a report

That lack of difference in survival rates may be due to the fact that prostate cancer is a slow-growing cancer, and the new study only looked at five years of data, says the study's lead author, Dr. Anthony Zietman, a professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School.

It might take as long as 10 to 20 years to see a difference, he explains.

In terms of cancer recurrence, however, higher-dose radiation showed a clear benefit, Dr. Zietman remarks.

"Men who had high-dose radiation were much less likely to have their cancer return than those with conventional radiation," he explains. "And, because the technology has gotten very accurate, there was very little price to pay for the increased [radiation] dose, in terms of side effects," including impotence.

September Focus on Prostate Cancer

September isNational Prostate Cancer Awareness Month. Almost 2 million American men are prostate cancer survivors, and more than 232,000 are diagnosed with the disease each year, according to theAmerican Cancer Society.

While as many as one in six men develops the disease over a lifetime, only one in 34 dies because of prostate cancer.

More than 26,000 American men choose radiation to treat their prostate cancer, the researchers note. Recurrence of prostate cancer, despite conventional radiation therapy, is common.

The majority of cases of prostate cancer now diagnosed in the US are detected while the disease is still clinically localized. External beam radiation is one of the options used to treat more than 26,000 US men annually.

External beam therapy is a type of therapeutic radiology that is delivered externally from a machine directed to the cancer inside the patient. External beam therapy delivers ionizing radiation to the cancer, destroying cancer cells.

Failure after treatment with conventional radiation therapy is common, with a resultant increase in prostate-specific antigen (PSA) levels, secondary treatment, and, ultimately, clinical recurrence, according to theJAMA press statement.

Technology Improves Accuracy

Increasing the delivered radiation dose may increase the probability of local tumor control but carries a risk of greater adverse effects unless the volume of normal tissue treated along with the tumor can be reduced, the researchers remark.

Dr. Zietman says that during the past 10 years, radiation technology has improved dramatically, and physicians can now deliver higher doses of radiation more accurately than they could in the past.

To deliver the higher-dose radiation therapy, the researchers used proton beam therapy, a newer type of external beam therapy that is currently available in only a few centers in the US. Proton beam therapy utilizes beams of proton particles, rather than gamma rays or x-rays.

To see if these higher doses of radiation could help prevent some cases of recurrence, Dr. Zietman and his colleagues compared 197 men who received conventional radiation to 195 who received high-dose radiation to treat early prostate cancer.

The average age of the men was 67 for the conventional group and 66 for the high-dose group. Most of the study volunteers were Caucasian, the researchers note.

Just over 61 percent of men on conventional radiation remained cancer-free after five years, while 80 percent of those treated with high-dose radiation had no cancer recurrence, the researchers found.

According to Dr. Zietman, the finding suggests that "men need to be asking radiation oncologists if they are just having conventional radiation, or if they're going to take advantage of the technology to deliver higher doses."

Dr. Theodore DeWeese, co-author of an editorial in the same issue ofJAMA and chairman of the department of radiation oncology and molecular radiation sciences at Johns Hopkins University School of Medicine, points out that not all hospitals can provide high-dose radiation yet.

He says the benefits of high-dose radiation generally outweigh the potential risks, "with the proviso that the physicians and the institution are capable of delivering these high doses safely."

Right now, he says, that means getting treatment at larger medical centers. But, he adds, smaller community hospitals will likely have the technology soon as well.

"If you're otherwise healthy, with a life expectancy of at least 10 years, aggressive management of prostate cancer is likely to benefit you, and to reduce recurrence," Dr. DeWeese notes.

Men need to discuss all the treatment options with their physician, and then decide which one has the most acceptable side-effect profile, says Dr. DeWeese.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.


Prostate Cancer Guide

The Prostate Cancer Foundation (PCF) recently released its inaugural Report to the Nation on Prostate Cancer: A Guide for Men and Their Families, designed for patients and caregivers.

In addition, the PCF released its second annual Report to the Nation on Prostate Cancer: Focus on Advanced Disease specifically for the medical community.

According to the PCF, one in six men will develop prostate cancer in their lifetimes. This year, more than 232,000 men will be diagnosed with prostate cancer. As the baby boomer generation ages into the target zone, the expectation is that the number of diagnoses may jump 40 to 50 percent in the next decade.

As part of a nationwide effort to promote awareness and education during Prostate Cancer Awareness Month, the guides were developed to assist both the professional community and the nearly 2 million men currently battling prostate cancer, to navigate the often challenging treatment decision-making process.

Both guides were authored and edited by leading US prostate cancer specialists.

The main goal of the patient guide, says the PCF, is to empower men with prostate cancer and their families to become active members of the treatment “team,” which is achieved by offering them the same information as the physicians, but written specifically in an easy-to-read format.

The guide balances practical tips with the latest information on treatment innovations and developments in the field of prostate cancer care, and includes tear-out sheets and wallet-sized cards listing issues to consider and important questions for men to ask their physicians at each stage of disease.

The patient guide addresses common questions, such as:

  • How do I know if I should choose radiation therapy or surgery for my initial treatment?
  • What are the latest innovations in treatment delivery that I should ask my physician?
  • Why is it important to monitor my PSA level when I have prostate cancer?
  • What do I need to know about how hormone therapy works?
  • How can chemotherapy help me?
  • Are there new drugs on the market, or that are being tested, that might help me?
  • What kinds of side effects can I expect from each treatment option and how can I minimize the way they affect my life?

Always consult your physician for more information.

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