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Letters Prostatectomy v radiotherapy

Prostatectomy v radiotherapy: possible detrimental effect of hormonal manipulation in patients receiving radiotherapy

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2273 (Published 25 March 2014) Cite this as: BMJ 2014;348:g2273

Re: Prostatectomy v radiotherapy: possible detrimental effect of hormonal manipulation in patients receiving radiotherapy

The hypothesis that the hormone therapy is detrimental to prostate patients undergoing radiotherapy remains to be proven in randomised trials.[1].

On the contrary, high quality evidence, from phase III randomised trials conducted in USA and Europe, conclusively demonstrate the hugely beneficial survival effect of hormone therapy. [2][3].

For instance, a European Organisation for Research and Treatment of Cancer (EORTC) trial showed that 10-year overall survival was overwhelmingly better if hormone therapy was added to radiotherapy (39•8% versus 58•1%). [2].

A phase III randomised trial from Dana-Farber/Harvard Cancer Center also showed remarkably better 5-year survival rates for the addition of hormone therapy to radiotherapy (88% versus 78%).[3].

While hormone therapy can cause various undesirable side effects, the current evidence indicates that they are of net benefit to patients having radiotherapy.[1][4]. The role of hormones with escalated doses of radiotherapy and in certain subgroup of patients would need evaluation in future trials. But, at present, the combination of radiotherapy and hormone therapy, as endorsed by various guidelines, remains the standard of care for intermediate risk and locally advanced prostate cancer [4].

References

1 Eden CG. Prostatectomy v radiotherapy: possible detrimental effect of hormonal manipulation in patients receiving radiotherapy. BMJ 2014;348:g2273.

2 Bolla M, Van Tienhoven G, Warde P, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 2010;11:1066–73. doi:10.1016/S1470-2045(10)70223-0

3 D’Amico AV, Manola J, Loffredo M, et al. 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. Jama J Am Med Assoc 2004;292:821–7. doi:10.1001/jama.292.7.821

4 Thomas BC, Neal DE. Androgen deprivation treatment in prostate cancer. BMJ 2013;346:e8555–e8555. doi:10.1136/bmj.e8555

Competing interests: No competing interests

31 March 2014
Santhanam SUNDAR
Nottingham University Hospitals NHS Trust
Consultant Oncologist
Dept of Oncology, Hucknall Road, Nottingham. NG5 1PB