New approach to prostate cancer improves 5-year survival

A combination of hormone therapy and pelvic lymph node radiation improves survival of prostate cancer patients, researchers reported on May 26, 2022 in The Lancet.

“We can now confirm that pelvic lymph node treatment used together with androgen deprivation therapy, or even used as a stand-alone treatment option, greatly improves outcomes in patients with postoperative prostate cancer,” said senior author Howard Sandler, MD, chair of the Department of Radiation Oncology at Cedars-Sinai Cancer in Los Angeles. “These findings are an encouraging step forward, both for the medical community and for the patients and their loved ones seeking curative treatment options.”

Researchers from the Phase III SPPORT trial enrolled 1792 subjects, 1,716 of whom were eventually evaluable.

Eligible subjects (aged ≥18 years) had undergone a prostatectomy for adenocarcinoma of the prostate and had a persistently detectable or an initially undetectable and rising PSA of between 0.1 and 2.0 ng/mL.

The investigators designed the three-group randomized trial to measure improvements in patient survival resulting from addition of either short-term androgen deprivation therapy to salvage prostate bed radiotherapy, or addition of both short-term androgen deprivation therapy and pelvic lymph node radiotherapy to salvage prostate bed radiotherapy.

Group one (n=592) received standard salvage prostate bed radiotherapy. Group two (n=602) received salvage prostate bed radiotherapy along with androgen deprivation therapy. Group three (n=598) received salvage prostate bed radiotherapy, androgen deprivation therapy and pelvic lymph node radiation.

At a median follow-up among survivors of 8.2 years, the 5-year freedom-from-progression rates were 70.9% in group one, 81.3% in group 2 and 84.7% in group 3.

“The combined treatment approach proved to be the most beneficial approach,” said Sandler.

The authors concluded, “The results of this randomised trial establish the benefit of adding short-term ADT [androgen deprivation therapy] to PBRT [prostate bed radiotherapy] to prevent progression in prostate cancer. To our knowledge, these are the first such findings to show that extending salvage radiotherapy to treat the pelvic lymph nodes when combined with short-term ADT results in meaningful reductions in progression after prostatectomy in patients with prostate cancer.”