Prostate Cancer Radiation Therapy Timing Studied
Newly diagnosed prostate cancer patients can safely delay the onset of radiation treatment by several months without risking their long-term prognosis, according to a report in the medical journal Cancer.
Researchers explored the risks posed by a delay of up to nine months in starting a radiation treatment known as external beam radiation therapy (EBRT) post-diagnosis.
EBRT is one of several therapy options available to prostate cancer patients, along with surgery, hormone treatment, and intensity-modulated radiation therapy.
"The bottom line is that with this form of treatment you can wait an extended period of time, and we couldn't find a major disadvantage to that," says study co-author Dr. Alan Pollack, chairman of the radiation oncology department at the Fox Chase Cancer Center in Philadelphia.
"And this is comforting to know - that if men postpone treatment a little bit, their outcome should not be compromised," says Dr. Pollack.
According to the American Cancer Society, prostate cancer is the most common type of cancer among men in the US, other than skin cancer. More than 230,000 Americans are diagnosed with the disease each year, resulting in approximately 30,000 fatalities annually.
Treatment delays of several months are quite common for men diagnosed with prostate cancer and can cause patients concern and anxiety, the researchers say.
Dr. Pollack and his colleagues analyzed the treatment results of more than 1,300 men who had sought medical care for prostate cancer at the Fox Chase Cancer Center between 1981 and 2001.
The researchers say all the men had undergone either conventional EBRT or a newer form of EBRT known as three-dimensional conformal radiation therapy (3DCRT).
Both therapies deliver targeted high-energy radiation to kill prostate cancer cells and shrink tumors.
However, the 3DCRT technology relies on a sophisticated computer to more accurately pinpoint and target the prostate cancer cells with a high dose of radiation. This therapy entails the wearing of a Styrofoam body cast to keep the patient still and protected, the researchers say.
The researchers assessed differences in the spread of the cancer, treatment failure, and long-term survival rates among the patients based on how long a period of time had elapsed between the initial prostate cancer diagnosis and the start of either form of radiation therapy.
Patients were grouped according to whether they had begun radiation therapy less than three months, between three and six months, between six and nine months, or more than nine months after diagnosis.
Dr. Pollack and his team found that the long-term cancer prognosis did not appear to differ, regardless of when radiation treatment had been initiated.
The researchers further found that patient outcomes were the same across low- to high-risk grades of prostate cancer.
The authors conclude that although radiation therapy should optimally be administered as soon after an initial prostate cancer diagnosis as possible, it did not appear that a nine-month delay of such treatment raised the risk for a worse result down the road.
They specifically suggest, however, that high-risk prostate cancer patients should not delay radiation therapy.
"Men with high-risk disease shouldn't postpone treatment," explains Dr. Pollack. "We definitely need more research and I wouldn't say the findings are yet fully conclusive, especially for high-risk men.
"But for men with favorable or intermediate risk, I think everyone is in agreement that postponement of radiation treatment is not critical, so you can wait and get an informed decision without having to immediately undergo treatments that entail serious side effects," he says.
Dr. Howard L. Kaufman, associate director of Columbia University Cancer Center, suggests that more study is needed to fully appreciate the pros and cons of radiation treatment delays.
"One of the concerns we have as physicians is how soon do we have to do treatment after diagnosis, and there's a lot of anxiety over this question," says Dr. Kaufman. "So, it's encouraging that this study suggests that it may be appropriate to delay the start of treatment for several months, and I think people should feel better when that happens."
"On the other hand," he adds, "I think the findings should be interpreted cautiously. It's related to a specific type of radiation therapy. And it also looks like the patients that were evaluated mostly had low-grade or low-risk prostate cancer, and we know that the disease may progress more slowly in this group of patients.
"So, we should do more studies like this, because these are really important questions," Dr. Kaufman emphasizes.
Always consult your physician for more information.
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According to the National Cancer Institute (NCI), if a person has been diagnosed with prostate cancer, an array of treatment options will be made available.
A course of action will, to some extent, be influenced by the character of the cancer.
A person's decisions should also reflect personal priorities after weighing each potential benefit and possible harm for the treatment options available.
A person's age and health should also be considered.
Treatment decisions are complicated by shortcomings in both prognosis and treatment, the NCI states.
Although an individual's Gleason score (a system for grading prostate cancer, based on a number range from 2 to ten) and PSA level provide good guidelines, there is still no way to know for sure how rapidly the prostate cancer will progress.
Nor are there any results available from clinical trials that directly compare different types of treatment for similar stages of disease to help a person evaluate possible options, states the NCI.
NCI provides the following questions to consider:
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Is your cancer truly confined to the prostate gland, or has it spread to nearby - or even distant - parts of your body?
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Is it aggressive or slow-growing?
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What is your general health status?
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Are you young enough so that even a slow-growing cancer might someday pose a threat?
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Are you healthy enough for surgery?
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Are you willing to risk serious, lifelong side effects to possibly reduce your chances of a cancer death?
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How important is it for you, in your work or recreation, to maintain bladder or bowel control?
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How important is it to be able to have erections?
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Or would you find it too worrisome to live with an untreated cancer, too stressful to face frequent monitoring?
If a man's prostate cancer is confined to the gland, or localized (Stage I or II/low Gleason score), he is a good candidate for treatments that can result in long-term survival, the NCI states. There are three main approaches to managing localized cancer: watchful waiting, surgery, and radiation therapy.
According to the NCI, watchful waiting is based on the premise that cases of localized prostate cancers may advance so slowly that they are unlikely to cause men - especially older men - any problems during their lifetimes.
Some men who opt for watchful waiting, also known as "observation" or "surveillance," have no active treatment unless symptoms appear. They are often asked to schedule regular medical checkups and to report any new symptoms to the physician immediately.
Watchful waiting has the obvious advantage of sparing a man with clinically localized cancer - who typically has no symptoms - the pain and possible side effects of surgery or radiation.
On the minus side, watchful waiting risks decreasing the chance to control disease before it spreads, or postponing treatment to an age when it may be more difficult to tolerate. Of course, treatments may also improve over time if watchful waiting is chosen. Another potential disadvantage is anxiety; some men do not want the worry of living with an untreated cancer.
The most obvious candidates for watchful waiting are older men whose tumors are small and slow growing, as judged by low grade/Gleason score and low stage, the NCI states.
Always consult your physician for more information.
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