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Chemo-radiation before prostate removal may prevent cancer recurrence
November 05, 2009OHSU Knight Cancer Institute findings prompt Phase II clinical trial for high-risk prostate cancer patients
PORTLAND, Ore. - Researchers in the Oregon Health & Science University Knight Cancer Institute and the Portland Veterans Affairs Medical Center have found a combination of radiation therapy and chemotherapy given before prostate removal is safe and may have the potential to reduce cancer recurrence and improve patient survival.
Their findings were presented this week at the 51st annual meeting of the American Society of Therapeutic Radiology and Oncology in Chicago.
"In men with aggressive prostate cancer, standard therapies such as radiation or surgery often fail to eliminate the cancer completely at the site of treatment. When these cancers recur, they are often fatal," said Mark Garzotto, M.D., principal investigator and Associate Professor of Urology and Radiation Medicine in the OHSU Knight Cancer Institute; and Chief of Urologic Oncology in the Portland Veterans Affairs Medical Center.
Previous clinical trials examining the effect of either hormonal therapy or chemotherapy prior to surgery have shown little if any benefit over prostate removal alone. "Novel approaches are needed if we are to make advances in this disease," added Dr. Garzotto.
The use of multimodality therapy - combined radiation, chemotherapy and surgery - has resulted in improved outcomes in a number of cancers, but has not yet been studied in prostate cancer.
This study looked at whether radiation therapy and chemotherapy (docetaxel) administered before surgery is possible, safe, and, ultimately, capable of preventing cancer recurrences. To answer these questions, Garzotto and colleagues developed a treatment regimen in which radiation and docetaxel were administered together before prostatectomy.
Twelve eligible participants were enrolled in the study between April 2006 and March 2008. The men were given intensity-modulated radiation therapy and increasing doses of docetaxel for five consecutive weeks, which was followed by surgical removal of the prostate gland.
The participants tolerated the treatment well and were able to undergo surgery without any major complications, which was a potential concern in this trial. Specifically there were no rectal or ureteral injuries or blood clots in the legs. Examination of the tumor tissue after surgery showed the cancer margins, evidence of complete removal of all of the cancer, to be clean in 75 percent of patients, which is higher than was expected. Also, the PSA, or prostate-specific antigen levels, a predictor of prostate cancer recurrence, were undetectable after treatment in all patients.
"Our study is the first-ever clinical trial in prostate cancer to combine radiation, chemotherapy and surgery given as a combination treatment before prostate surgery to potentially provide higher cure rates than traditional approaches with fewer side effects," said Arthur Hung, M.D., co-investigator and Assistant Professor of Radiation Medicine in the OHSU Knight Cancer Institute.
The researchers concluded this chemo-radiation combination is feasible and safe and potentially may reduce cancer recurrence rates in this high-risk population. Further, they say the development of this approach now opens the door to the study other drugs in combination with radiation.
Oregon Health & Science University
"In men with aggressive prostate cancer, standard therapies such as radiation or surgery often fail to eliminate the cancer completely at the site of treatment. When these cancers recur, they are often fatal," said Mark Garzotto, M.D., principal investigator and Associate Professor of Urology and Radiation Medicine in the OHSU Knight Cancer Institute; and Chief of Urologic Oncology in the Portland Veterans Affairs Medical Center.
Previous clinical trials examining the effect of either hormonal therapy or chemotherapy prior to surgery have shown little if any benefit over prostate removal alone. "Novel approaches are needed if we are to make advances in this disease," added Dr. Garzotto.
The use of multimodality therapy - combined radiation, chemotherapy and surgery - has resulted in improved outcomes in a number of cancers, but has not yet been studied in prostate cancer.
This study looked at whether radiation therapy and chemotherapy (docetaxel) administered before surgery is possible, safe, and, ultimately, capable of preventing cancer recurrences. To answer these questions, Garzotto and colleagues developed a treatment regimen in which radiation and docetaxel were administered together before prostatectomy.
Twelve eligible participants were enrolled in the study between April 2006 and March 2008. The men were given intensity-modulated radiation therapy and increasing doses of docetaxel for five consecutive weeks, which was followed by surgical removal of the prostate gland.
The participants tolerated the treatment well and were able to undergo surgery without any major complications, which was a potential concern in this trial. Specifically there were no rectal or ureteral injuries or blood clots in the legs. Examination of the tumor tissue after surgery showed the cancer margins, evidence of complete removal of all of the cancer, to be clean in 75 percent of patients, which is higher than was expected. Also, the PSA, or prostate-specific antigen levels, a predictor of prostate cancer recurrence, were undetectable after treatment in all patients.
"Our study is the first-ever clinical trial in prostate cancer to combine radiation, chemotherapy and surgery given as a combination treatment before prostate surgery to potentially provide higher cure rates than traditional approaches with fewer side effects," said Arthur Hung, M.D., co-investigator and Assistant Professor of Radiation Medicine in the OHSU Knight Cancer Institute.
The researchers concluded this chemo-radiation combination is feasible and safe and potentially may reduce cancer recurrence rates in this high-risk population. Further, they say the development of this approach now opens the door to the study other drugs in combination with radiation.
Oregon Health & Science University
Prostate Cancer Current Events and Prostate Cancer News RSSLower detection of prostate cancer with PSA screening in US than in a European randomized trial
Fewer prostate cancers were detected by prostate-specific antigen (PSA) screening in the U.S. than in a European randomized trial because of lower screening sensitivity, according to a new brief communication published online February 8 in the Journal of the National Cancer Institute.
Loss of gene function makes some prostate cancer cells more aggressive, researchers find
Prostate cancer cells are more likely to spread to other parts of the body if a specific gene quits functioning normally, according to new data from researchers at UT Southwestern Medical Center.
Vaccine approach extends life of metastatic prostate cancer patients
In a newly published clinical trial, patients with metastatic prostate cancer who received a vaccine of harmless poxviruses engineered to spur an immune system attack on prostate tumor cells lived substantially longer than patients who received a placebo vaccine, report researchers at Dana-Farber Cancer Institute and affiliated organizations.
Study confirms prostate cancer is treated differently at county vs. private hospitals
Researchers at Moores Cancer Center at the University of California, San Diego and colleagues have found that prostate cancer treatments varied significantly between county hospitals and private providers.
Gender-biased heart damage
A man's male hormones may ward off heart damage by helping vessels around the heart regenerate, suggest Australian researchers in a report posted January 13 in the Journal of Experimental Medicine.
Incidental findings at MRI-enterography
MRI is increasingly used in the assessment of small bowel CD. Unlike conventional radiology, MRI enables visualization of disease extension beyond the intestinal wall, i.e., abscesses and fistulas.
Race, obesity affect outcomes among diabetics following prostatectomy
Obese white men who have both diabetes and prostate cancer have significantly worse outcomes following radical prostatectomy than do men without diabetes who undergo the same procedure, according to research from Duke University Medical Center appearing in Cancer Epidemiology, Biomarkers & Prevention.
Discovery at JGH opens door to new treatments for prostate, brain and skin cancers
Researchers at the Lady Davis Institute for Medical Research of the Jewish General Hospital and McGill University in Montreal have discovered a previously unsuspected link between two different genetic pathways which suppress the growth of cancer tumours.
Intermittent androgen deprivation at least as effective as continuous androgen deprivation
Potential Benefits of Intermittent Androgen Suppression Therapy in the Treatment of Prostate Cancer: A Systematic Review of the Literature' is the title of an article by P-A. Abrahamsson in the January issue of European Urology, the official journal of the European Association of Urology.
Sexual function does not continuously decline after radiation therapy treatments for prostate cancer
Sexual function in prostate cancer patients receiving external beam radiation therapy (EBRT) decreases within the first two years after treatment but then stabilizes and does not continuously decline as was previously thought.
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