is More" in the Treatment of Prostate Cancer
scientists at Dana-Farber Cancer Institute (DFCI) in Boston have made a
discovery about the treatment of prostate cancer. Less is more. "Certain
prostate cancer patients who receive conformal beam radiation followed by six
months of hormone therapy for localized prostate cancer survive longer than those
who receive three years of the grueling anti-androgen treatment," they announced.
latest findings, published in August in the Journal of the American Medical
Association, challenge the current 'gold standard' of prostate cancer treatment,
which is two months of highly targeted radiation therapy followed by a full three
years of hormone suppression therapy. The authors of the Dana-Farber study concede
that this combined regimen is associated with "negative side effects significantly
impacting quality of life."
sometimes quality of life is a nebulous concept that tends to get pushed into
second place when new treatments are being considered, in this case it has a tangible
influence on patients' survival. Androgen suppression therapy (AST) when
used for more than one year causes "significant side effects, including bone
density loss, impaired memory, anemia, breast enlargement, hot flashes, and impotence
in some patients, especially those who are elderly" (DFCI 2004). And
this sometimes translates into shorter survival as well.
endorsement of a more conservative treatment from one of America's top cancer
centers is certainly welcome news. It means that those facing treatment for locally
advanced prostate cancer may now be spared distressing, and sometimes even life-threatening,
it is ironic that here is yet another example of a major 'advance' that consists
of sparing patients from the previous excesses of zealous doctors. It reminds
me of how the NCI used to claim the demise of the Halsted radical operation
for breast cancer as one of its own major achievementswhen in fact the NCI
had simply given in to the increasingly incontrovertible protests of mavericks
in the field.
Dana-Farber study shows that androgen suppression therapy (AST) coupled
with radiation is better than radiation alone.
to the lead investigator, Anthony D'Amico, MD, PhD, "This is the first study
to provide evidence that radiation therapy (in this case, the newer, more precisely
targeted 'conformal' radiation) combined with six months of AST provides
a survival benefit for those with early-stage prostate cancer."
to the National Cancer Institute, an earlier meta-analysis (a way of combining
data from several previous trials in order to gain greater objectivity) had found
"a difference in 5-year overall survival in favor of radiation therapy plus
continued androgen suppression compared to radiation therapy alone" (Seidenfeld
the Dana Farber study, there was no head-to-head comparison of six months vs.
three years of androgen suppression therapy. Instead, what was proven was the
superiority of AST + radiation vs. radiation alone. Researchers randomly assigned
206 patients to receive either two months of radiation therapy in conjunction
with six months of AST or two months of radiation therapy alone. Patients were
studied for an average of four-and-a-half years. Of the patients who were treated
with radiation alone, 22 percent died by the end of the study. But among those
who also received six months of hormone blockade (AST) 12 percent died. This 10
percent improvement was statistically significant.
with prostate cancer face a wide variety of decisions regarding their treatment,
each with its own distinct benefits and risks," said senior author Philip
Kantoff, MD. "Six months of hormone therapy combined with radiation therapy
is an effective treatment and provides patients with an important option if they
are concerned about hormone therapy-related side effects" (DFCI 2004). And
how many patients facing the side effects of long-term hormone ablation wouldn't
is directed by Ralph W. Moss, Ph.D. Dr. Moss is the author of eleven acclaimed
books including Antioxidants Against Cancer, Herbs Against Cancer, Questioning
Chemotherapy, and Cancer Therapy. He consults for thousands of clients through
his Moss Reports service. The
Moss Reports specializes in educating cancer patients about the most promising
alternative treatments for their condition.
Cancer Institute (DFCI). Short course of hormonal therapy improves survival in
prostate cancer patients treated with radiation therapy. Press
release, August 17, 2004.
DJ, Seidenfeld J, Schmitt B, et al. Systematic review and meta-analysis of monotherapy
compared with combined androgen blockade for patients with advanced prostate carcinoma.
J, Samson DJ, Hasselblad V, et al. Single-therapy androgen suppression in men
with advanced prostate cancer: a systematic review and meta-analysis. Ann Intern
J, et al. Relative Effectiveness and Cost-Effectiveness of Methods of Androgen
Suppression in the Treatment of Advanced Prostatic Cancer. Evidence
Report/Technology Assessment Number 4 Prepared for: Agency for Health Care
Policy and Research, AHCPR Pub No. 99-E011. Current as of January 1999.
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