August 18, 2004

By LINDSEY TANNER

CHICAGO (AP) -- Men with prostate cancer that doesn't appear to have
spread have better survival chances when they get short-term hormone
treatment along with standard radiation, rather than radiation alone, a
small study found.

Almost five years after treatment, six men in the radiation-only study
group died of prostate cancer; none of the men who got combined
treatment died of prostate cancer. The study involved about 200 men.

Of the more than 200,000 U.S. men diagnosed each year with the disease,
nearly half have the kind cancer involved in the study: An exam and
imaging indicates it hasn't spread but other tests indicate it might
have.

Treatment for such men often involves radiation alone or radiation
combined with long-term use of hormone-fighting drugs, often for as long
as three years or more. But long-term drug use may cause thinning bones,
heart abnormalities that can lead to sudden death and impaired mental
function.

  The study found that using hormone-blocking drugs for six months had
the same survival benefits as long-term use but without the potential
health risks. Some men did have side effects including impotence, but
that can occur with other prostate cancer treatments, including surgery
and radiation.

"It's a very important and useful study and should have nearly immediate
impact on the fashion in which men are treated," said Dr. Durado Brooks,
director of prostate cancer programs at the American Cancer Society.

"Significant numbers of men are getting radiation only," Brooks said.
That's partly because many men reject hormone-suppressing drugs when
they learn about all the bad side effects from long-term treatment, he
said.

Brooks said radiation plus short-term medication is likely to become
prevalent given the study results.

Researchers studied 206 men aged 49 to 82 randomly assigned to receive
about seven weeks of daily radiation treatments, or radiation plus six
months of medication overlapping the radiation treatment. Six of those
only on radiation died from prostate cancer while none of those getting
combined treatment died from prostate cancer.

More than twice as many radiation-only men had evidence of cancer
recurrence, 46 versus 21 in the combined treatment group.

The study by researchers at Boston's Brigham and Women's Hospital and
Dana Farber Cancer Institute appears in Wednesday's Journal of the
American Medical Association.

The patients had prostate cancer that physical exams and imaging tests
indicated had not spread. But they also had high blood levels of PSA -
prostate specific antigen - and high Gleason scores, which measure the
degree of abnormality found in cancer tissue.
The high levels raise the possibility of cancer elsewhere, said lead
author Dr. Anthony D'Amico, a radiation oncologist at both institutions.

The drug treatment studied involved flutamide pills three times daily
with periodic injections of either leuprolide acetate or goserelin. The
drugs suppress production of testosterone, which can fuel prostate
cancer growth.

Men in the drug-radiation group had more severe impotence and more
breast tissue enlargement than the radiation only group. But they had no
obvious evidence of the potentially more debilitating complications of
long-term treatment. Although those weren't specifically measured, they
usually don't appear until after at least a year of treatment, D'Amico
said.
In a JAMA editorial, Dr. Theodore DeWeese of Johns Hopkins University,
said the study did not address how the drug treatment affected patients'
quality of life. He also said the radiation dose was lower than is
frequently given, which might explain the differing survival rates.
Still, he called the study "extremely important" because of the survival
advantage shown.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."