Analysis of Multiple Treatments

A systematic review of randomized trials in localized prostate cancer

Canadian Journal of Urology 1(1):2110-2117, February 2004
S M Alibhai and L H Klotz

Study purpose: his Canadian overview looks at studies from 1966 to 2003 that compare treatments for “localized” prostate cancer within the prostate gland. The treatments compared are radical prostatectomy (surgery to remove a cancerous prostate), external beam radiotherapy (radiation beamed throughout the body), brachytherapy (pellets implanted in the prostate that emit radiation), androgen-deprivation therapy (drugs that block the body’s male hormones from aiding prostate cancer cells), and watchful waiting (observation of the patient).

Conclusions: The authors feel that one study shows “high-quality evidence” in favour of surgery over watchful waiting for cancer in the prostate gland that is growing at a moderate rate.

Note: Two of the four studies were done in U.S. Veterans hospitals and had few participants and many limitations in method. Most tumours in the studies were not diagnosed by screening programs for prostate cancer, such as digital rectal exams done by physicians and serum prostate-specific antigen (PSA) testing. Further studies examining the treatment of localized prostate cancer detected by screening are needed; several are now underway.

The Management of High Risk Prostate Cancer

Journal of Urology 169(6):1993-1998, June 2003
Bulent Akduman and E David Crawford

Study purpose: To study the recurrence (return) of high risk prostate cancer after treatment. Prostate cancer may recur after “local” therapy targeting the tumour, or return after “systemic” therapy that affects the whole body. There is no agreement among doctors about treatment for these patients. This review defines high risk prostate cancer and looks at how its recurrence can be treated by radiation therapy, androgen-deprivation therapy (which stops body hormones aiding prostate cancer), and chemotherapy.

Study description: Internet medical databases were searched for all relevant studies.

Findings: Results show that deciding if a man has high risk prostate cancer is important after diagnosis. To do so, doctors look for cancer in the lymph nodes of the pelvis and in the seminal vesicles, glands near the prostate that secrete seminal fluid. They also look at how fast serum prostate-specific antigen (PSA) scores jump on standard PSA tests — quickly climbing results may indicate a fast-growing cancer. Finally, physicians use the Gleason score, a method that classifies prostate cancer aggressiveness. Numbers up to ten indicate increasingly fast growing cancers. A number of therapies now try to treat recurrent prostate cancer or devise ways to prevent its recurrence. For example, while a man getting radiotherapy early on in his disease won’t live longer, he may live for a longer period without the cancer returning. There is no real evidence that early androgen deprivation therapy prolongs patient’s lives, but increased time to the worsening of cancer and excellent pain-relief in unresponsive cases was seen in most of the studies. Chemotherapy trials showed that patients lived longer after being given early chemotherapy alone or alongside androgen-deprivation therapy. Patients whose cancer was not spreading benefited the most.

Conclusions: Patients whose prostate cancer returns after primary therapy can benefit from radiotherapy, androgen-deprivation therapy, chemotherapy, or a combination of therapies.