Early Radiation Therapy Extends Prostate Cancer Survival
By Holly VanScoy, HealthDay Reporter
FRIDAY, June 25 (HealthdayNews) -- Prostate cancer patients who receive radiation therapy within six months of surgery typically live longer than patients who don't receive early radiation treatment, a new Italian study finds.
"Our results show that radiation therapy after prostate surgery helps limit the chances that the cancer will recur, allowing patients to live longer," said Dr. Cesare Cozzarini, a radiation oncologist at San Raffaele H. Scientific Institute in Milan, and the study's principal investigator.
"To my knowledge, this is the largest study of its kind completed at a single institution," he added.
The researchers examined the records of 415 men with prostate cancer who underwent surgery to remove their prostate and surrounding lymph nodes between 1986 and 1999 at the Institute.
Two groups of post-surgical patients were studied -- one group included men who received external beam radiation therapy within six months of their prostate operation; the other included men whose physicians followed them over time and provided radiation therapy only if their cancers showed signs of returning. None of the men whose records were studied had metastatic disease -- that is, cancer in areas of the body other than the prostate.
After eight years of follow-up, the survival rate for men receiving early radiation therapy was 69 percent, compared to 31 percent for those who had radiation therapy more than six months after their surgeries or not at all.
The researchers also found that the disease remained localized in the prostate for 93 percent of the patients in the early radiation therapy group, compared to 63 percent in the other group. The risk of death from localized prostate cancer was also significantly lower for men receiving post-surgical early radiation therapy.
Results of the study will appear in the July issue of the International Journal of Radiation Oncology*Biology*Physics, a publication of the American Society for Therapeutic Radiology and Oncology.
Dr. Eric Horwitz is associate professor and Director of the Radiation Oncology Training Program at Fox Chase Cancer Center in Philadelphia. He said the Italian study is the first to offer evidence about whether radiation treatment soon after prostate surgery actually improves a man's chances of survival.
"These results provide oncologists, urologists and radiologists with another important piece of the prostate cancer treatment puzzle," Horwitz said. "The study included a significant number of patients and included many follow-up details about these men five and eight years later. Most importantly, it also provides valuable information about whether they survived, not just about their levels of prostate specific antigen (PSA), which is what most previous studies have reported."
Dr. E. Roy Berger, M.D., founding member of the Prostate Cancer Education Council, noted that the Milan research and similar recent studies are moving the treatment of prostate cancer along the same path recently traveled by breast cancer patients and physicians.
"Five years ago, radical mastectomy was the only way to go in breast cancer treatment," he said. "Today there's been so much good research about the positive outcomes of other treatment approaches that chemotherapy, radiation and less radical surgical interventions are widely used together -- and the breast cancer survival rates are improving."
Berger believes that "this is the same course the treatment of prostate cancer is likely to follow, as understanding grows of the roles radiation, hormones and chemotherapy used together can play in saving men's lives."
Dr. Ronald Smialowicz, a urologist in private practice at St. Francis Memorial Hospital in San Francisco, concurred.
"The standard of care in prostate cancer is continuing to evolve," he said. "As is now the case in the treatment of breast cancer, the best outcomes will likely occur when prostate cancer treatment is highly individualized and men themselves participate in making an informed decision about what treatments they pursue at each point in their disease and recovery process."
Prostate cancer is the second most common malignancy affecting American men. The American Cancer Society estimates some 230,900 new cases will be diagnosed this year, with about 29,900 deaths. Only skin cancer is more prevalent. One American man in six will develop prostate cancer during his lifetime and one in 32 will die from the disease.
More information
For more on prostate cancer and its treatment, visit the National Cancer Institute (www.nci.nih.gov ). 
SOURCES: Cesare Cozzarini, M.D., Department of Radiochemotherapy, San Raffaele H. Scientific Institute, Milan, Italy; Eric Horwitz, M.D., associate professor and Director of the Radiation Oncology Training Program, Fox Chase Cancer Center, Philadelphia: E. Roy Berger, M.D., F.C.A.P., North Shore Hematology/Oncology Associates, P.C., East Setauket, N.Y.; Ronald Smialowicz, M.D., Urology, St. Francis Memorial Hospital, San Francisco; American Cancer Society Web site; July 2004, International Journal of Radiation Oncology*Biology*Physics
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