Adding radiation therapy to prostate cancer surgery has been a difficult requirement.New science eases the dilemma | Lifestyle

One of the most troublesome dilemmas caused by prostate cancer is whether and when to give men radiation therapy after surgery to remove the prostate.

Currently, three new randomized clinical trials (gold standard type studies) and the resulting statistical “meta-analysis” conclude that regular postoperative radiation does not improve outcomes after 5 years. It is attached. A PSA (Prostate Specific Antigen) blood test shows a recurrence of the cancer. The paper was published in The Lancet and Lancet Oncology last month.

“All surgeons have always struggled with this,” said Alexander Darktikov, a urological oncologist at the Foxchase Cancer Center. “You don’t want to over-treat, but you don’t want to lose the window of opportunity. These tests really embody that you can withhold radiation. It changed my habits.”

This change has benefited not only postoperative patients with Kutikoff, but also men like James Boater, 56, who had surgery six years ago.

“We were monitoring (PSA) every six months,” said Boughter, a machinist in Honeybrook, Chester County.

Buyer’s PSA was almost undetectable about a year ago, but is stable at its low levels. Based on the latest research, Kutikoff was able to assure Boughton that he could withhold radiation and hopefully abandon it altogether.

“If I had to do radiation, I would definitely do it if it treats cancer, but I would rather not,” Bouter said because of the risk of urine and other problems. ..

Claire Vale, a researcher at the University College London, who led the meta-analysis, said the study could save many men from overtreatment.

Diagnosis and treatment of prostate cancer begins with a PSA test to screen for the disease and involves a risk-benefit trade-off. Current guidelines state that doctors should not perform regular screening without first discussing concerns that could lead to the detection and treatment of small cancers that, if left untreated, would not pose a threat.

If early cancer is found, the gold standard treatment, especially for young men, is to surgically remove the walnut-sized prostate.

However, studies show that up to 40% of men (buyers among them) may be at increased risk of recurrence despite surgery. This is because the cancer was invasive, some malignant cells escaped during surgery, or the cancer had spread to tissues near the prostate.

The previous seven randomized trials failed in trying to clarify which men, if any, benefited from postoperative radiation, rather than waiting for PSA to rise. Radiation early rather than later reduced the risk of recurrence, but did not improve survival. In addition, the results were difficult to interpret because some studies did not monitor PSA levels, did not irradiate until the cancer progressed, or both.

According to the author of the accompanying commentary, new studies also have some possible limitations. For example, one study enrolled men who normally do not receive postoperative radiation because of their good risk profile. And the three trials differed in the use of drugs that block hormones that promote prostate cancer.

“Nevertheless, the four studies represent important progress and support,” said Derya Tilki of the Hamburg Eppendorf University Hospital in Germany and Anthony V of the Dana Farber Cancer Institute. D’Amico adds radiation only if the cancer has come back. Boston.

A meta-analysis of 2,153 patients followed for an average of 5 years found that 88% of men who refrained from radiation had no recurrence, compared to 85% who received radiation immediately after surgery. Of those who postponed, 67% did not yet need radiation until eight years later.

Urinary incontinence worsened in a year in men who received postoperative radiation therapy. Also, 6% had difficulty urinating due to damage to a tube called the urethra, compared to 4% of men who postponed radiation.

“The idea was that I was always missing out on opportunities,” Kutikoff said. “These studies tell me that even those men can be postponed even if they are at high risk of recurrence.”

___

(C) 2020 Philadelphia Inquirer

Visit the Philadelphia Inquirer. www.inquirer.com

Distributed by Tribune Content Agency, LLC.