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Reporter’s Notebook
— Prostate Cancer News From ASTRO 2007 Editor’s Note: These reports are compiled from press materials supplied by the American Society for Therapeutic Radiology and Oncology (ASTRO) at the society’s 49th annual meeting last month. Radiation Seed Implant
Decreases Risk of Death Over Watchful Waiting The study, “Radiation Therapy in Prostate Cancer Patients and Survival — A Population-based Study,” may be used to improve the selection of appropriate treatments since no single method of prostate cancer treatment has been shown in a randomized comparative trial to be better. Many men choose brachytherapy treatment, where a radiation oncologist places small radioactive seeds into the prostate to kill the cancer cells, because it is considered as effective as external beam radiation therapy and surgery. Unlike external beam, which is given over six to eight weeks, brachytherapy can be completed in one visit. It also has a faster recovery time than surgical prostatectomy. Watchful waiting, also known as active surveillance or observation, is an option for prostate cancer patients where doctors monitor the cancer through frequent tests to see if the tumor causes symptoms or appears to be growing. Unlike many other cancers, most prostate cancers grow very slowly and sometimes watching the cancer instead of actively treating it is the preferred choice, especially among older men who wish to avoid the side effects of treatment, including problems with urination and sexual function. “This is the first time that a population-based cohort study has compared brachytherapy to watchful waiting/active surveillance in the treatment of localized prostate cancer,” said Ester H. Zhou, MD, PhD, lead author of the study and an epidemiologist at the Case Western Reserve University School of Medicine in Cleveland. “We were pleasantly surprised to find that patients who had brachytherapy in conjunction with external beam radiation therapy and/or androgen deprivation therapy had much better survival than those patients who didn’t receive active treatment, and that it was shown to be just as effective as radical prostatectomy in lengthening the lives of prostate cancer patients.” The study involved approximately 11,000 Ohio men aged 65 and older and newly diagnosed with localized prostate cancer between 1999 and 2001. Researchers examined the group’s survival rate after seven years to see if they could detect a benefit between different common treatments for localized prostate cancer. Can Cholesterol-lowering
Drugs Make Radiation More Effective for Curing Prostate Cancer? The study, “Statin Use and Clinical Outcomes After High Dose Radiotherapy for Prostate Cancer,” demonstrated that the greatest benefit of statin medications was observed in patients who had more aggressive or advanced forms of prostate cancer. The research also showed that men who took statins during high-dose radiation therapy had a lower rate of the cancer spreading to distant parts of the body. “We were indeed surprised by the findings that statins used by these patients for other conditions were shown to improve the effectiveness of radiation treatment in killing prostate cancer cells,” said Michael J. Zelefsky, MD, the senior author of the study and a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York. “The use of statins during radiation may also be effective in the treatment of other types of cancer. However, more studies are necessary to explore the association between statins and radiation treatment in curing cancers.” The retrospective study involved nearly 900 men treated with high-dose radiation therapy for prostate cancer, some of whom were also taking statin drugs, from January 1995 to July 2000. Younger Men Derive Same
Brachytherapy Benefit as Older Men “These results suggest that brachytherapy is extremely effective in curing localized prostate cancer for men aged 60 and younger. When younger men are diagnosed with localized prostate cancer, they should be presented with all viable treatment options, including brachytherapy,” said Alice Y. Ho, MD, lead author of the study “Young Men Have Equivalent Biochemical Outcomes Compared to Older Men After Treatment with Prostate Brachytherapy.” Ho is a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York. “Every man with prostate cancer, regardless of his age, should have access to the treatment that is best for his cancer and lifestyle,” she added. Brachytherapy is an attractive treatment option for patients with prostate cancer because it has a shorter recovery time than surgery, and studies have shown brachytherapy to be as effective as surgery. However, surgeons have usually advised younger men to undergo surgery to remove all or part of the prostate over other treatments, such as seed implants, because they believed younger men could physically tolerate surgery better than older men. Also, they believed surgery was more effective than brachytherapy at curing prostate cancer over the long term. This meant that many younger men would undergo surgery without ever learning about other treatment options, such as brachytherapy or external beam radiation therapy. The large, retrospective study examined the outcomes of more than 1,700 men with localized prostate cancer who were treated with brachytherapy between 1990 and 2005 at Mount Sinai Medical Center in New York. Results show that younger men had the same excellent outcomes after undergoing brachytherapy as older patients. Walking Prevents Bone
Loss Caused by Prostate Cancer Treatment “Prostate cancer patients are not routinely advised to exercise. Walking is one tool that prostate cancer patients can use to improve their health and minimize the side effects of cancer and cancer treatments,” said Paula Chiplis, PhD, RN, lead author of the study and a clinical instructor and senior research assistant at Johns Hopkins Hospital in Baltimore. “Walking has no harmful side effects, if done moderately, but it can dramatically improve life for men suffering from side effects from some prostate cancer treatments.” Men with localized prostate cancer frequently receive radiation therapy followed by months of hormone therapy to treat their cancer. Radiation is used to kill the cancer cells, while hormone therapy decreases testosterone and estrogen that feed the cancer cells, thereby keeping the tumor from growing. Men undergoing hormone therapy lose 4% to 13% of their bone density on an annual basis compared with healthy men who lose between 0.5% to 1% per year beginning in middle age. Men are typically not thought to be at risk for osteoporosis and bone fractures; however, men receiving hormone therapy have a greater rate of bone loss than that of postmenopausal women. The study shows that prostate cancer patients undergoing hormone therapy who walked at a moderate pace roughly five times per week for 30 minutes maintained or gained bone density, while those who didn’t exercise lost more than 2% percent of their bone density in eight to nine weeks. The study “Effects of Exercise on Bone Loss & Functional Capacity during Prostate Cancer Treatment” involved 70 sedentary men with stage 1 to 3 prostate cancer who were randomly assigned to either participate in the exercise plan or usual care (not exercise) during radiation treatment, with more than one half also receiving hormone therapy. Researchers wanted to determine the effects of a nurse-directed, home-based walking program in maintaining physical function and managing cancer- and treatment-related symptoms during radiation and hormone treatment for prostate cancer patients.
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