Limited Benefit of Radiation Following Prostate Surgery

Study Shows Limited Benefit for Radiation After Prostate Surgery, but
Fewer Abnormal PSA Tests
11-14-2006 7:08 AM
By CARLA K. JOHNSON

CHICAGO -- When prostate surgery fails to remove all traces of cancer,
men face a decision about whether to have radiation therapy.

Radiation can lead to bowel and urinary problems, but patients might
find that risk acceptable if there were evidence it guaranteed a
longer, healthier life.

A new study finds no such guarantee. It suggests radiation following
surgery may not make a difference in how long a man lives, or in how
long he lives without his prostate cancer spreading.

Radiation did lessen the chances a man would have an abnormal PSA test,
an abnormal biopsy or other clinical finding showing prostate cancer's
return during the next 10 years, the researchers found.

The findings apply to up to 35,000 American men annually. That's how
many have their prostates surgically removed, but whose followup tests
show some cancer cells may linger in surrounding tissue.

The study will help each of these men "make the decision based on
whether he would want to trade off perhaps some bowel or urinary
complications to reduce his risk of cancer coming back," said study
co-author Dr. Ian Thompson, a urologist at the University of Texas
Health Science Center at San Antonio.

The study, appearing in Wednesday's Journal of the American Medical
Association, was funded by grants from the National Cancer Institute
and the National Cancer Institute of Canada.

Researchers tracked 425 men, ages 43 to 79, for an average of 10 years
following prostate removal. All the men had tests suggesting the
surgery had failed to remove all the cancer cells.

About half the men were randomly assigned to radiation treatment. The
others waited while doctors monitored their blood for PSA, or
prostate-specific antigen, an imperfect test that can indicate prostate
cancer.

Compared to the men who waited, the men who received radiation soon
after surgery cut in half their risk for a later abnormal PSA test or a
finding of cancer.

But the two groups showed no significant difference in survival _ or in
how long they lived without cancer spreading to other organs.

The study may have been too small to find a difference in survival,
said Dr. John Concato, a clinical epidemiologist at the VA Connecticut
Healthcare System who was not involved in the study. Or the men's
cancers may not have had a large effect on their life expectancy.

Radiation wasn't a perfect cure. Some men in both groups saw their
cancer spread, or metastasize: 17 out of 214 men in the radiation
group, and 35 out of 211 men in the waiting group.

The study didn't evaluate the cost of the two approaches, but radiation
therapy can cost up to $40,000, Thompson said.

Dr. Anthony D'Amico of Boston's Dana Farber Cancer Institute said he
doesn't expect a change in treatment in the United States because of
the findings, but European doctors might increase their use of
post-surgical radiation or PSA testing, which aren't used as commonly
there.

U.S. doctors will continue to choose radiation for more extreme cases,
and wait until the PSA test shows signs of cancer return for other men,
D'Amico said. He was not involved in the study.

"We have to use some clinical common sense," D'Amico said.

The prostate is a gland the size of a walnut under the bladder that
makes fluid for semen. Prostate cancer is second only to skin cancer in
its prevalence among American men.

About 234,000 U.S. men are expected to be diagnosed with it this year
and just over 27,000 will die of it. A diet high in fruits and
vegetables may reduce the risk.

Also in Wednesday's JAMA, a study from the U.S. Department of Veterans
Affairs found a surprisingly high number of elderly veterans, with no
previous history of prostate cancer, received screening PSA tests.
Current recommendations say doctors shouldn't test men with limited
life expectancies, but researchers found one-third of men older than 85
and in poor health got PSA tests.

___

On the Net:

JAMA: http://jama.ama-assn.org

This article is chock full of the usual journalistic
sensationalism, beginning with the misleading title.

> Radiation can lead to bowel and urinary problems, but patients
> might find that risk acceptable if there were evidence it
> guaranteed a longer, healthier life.
>
> A new study finds no such guarantee.

Guarantee? Is there any medical procedure for any illness that
comes with a guarantee? I'd like to see that guarantee.

> It suggests radiation following surgery may not make a
> difference in how long a man lives, or in how long he lives
> without his prostate cancer spreading.

"may not" - I guess we're still looking for guarantees.

....
> Radiation did lessen the chances a man would have an abnormal
> PSA test, an abnormal biopsy or other clinical finding showing
> prostate cancer's return during the next 10 years, the
> researchers found.
....
> But the two groups showed no significant difference in survival

Or maybe they took more than 10 years to die.

> _ or in
> how long they lived without cancer spreading to other organs.
....
> Radiation wasn't a perfect cure. Some men in both groups saw
> their cancer spread, or metastasize: 17 out of 214 men in the
> radiation group, and 35 out of 211 men in the waiting group.

I must be missing something here. Isn't "cancer spreading to
other organs" a "clinical finding showing prostate cancer's
return"? Isn't 35 compared to 17 showing a greater incidence of
cancer spreading to other organs?

Finally, my reading of this article is that the men who were not
assigned to the radiation group might also have received
radiation. The trial had to do with whether they received the
radiation after finding positive margins or positive lymph nodes,
etc. during surgery, and got radiation immediately, as compared
to men who waited until their PSA rose. But you'd have to read
the article carefully to realize that.

It's unfortunately the case that, in order to make a living,
journalists have to write about things they don't understand, but
make it seem as if they do.

Alan

Alan Meyer wrote:

> Guarantee? Is there any medical procedure for any illness that
> comes with a guarantee? I'd like to see that guarantee.
> "may not" - I guess we're still looking for guarantees.

I'd pretty much like a guaranteed benefit before accepting guaranteed
SEs, depending on the degree of each. Rabies shots after a rabid coyote
bite . . . no-brainer; debatable adjuvant tx for hypothetical potential
future PC recurrence . . . not so simple.

I.P.

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:yiv6h.81$FW6.22@newsfe03.lga...
> Alan Meyer wrote:
>
>> Guarantee? Is there any medical procedure for any illness that
>> comes with a guarantee? I'd like to see that guarantee.
>> "may not" - I guess we're still looking for guarantees.
>
> I'd pretty much like a guaranteed benefit before accepting guaranteed SEs, depending on
> the degree of each. Rabies shots after a rabid coyote bite . . . no-brainer; debatable
> adjuvant tx for hypothetical potential future PC recurrence . . . not so simple.
>
> I.P.

It's a tough call. Radiation will cause some side effects
for everyone, but not necessarily significant or long lasting.
It's really a question of probabilities. What are the probabilities
of harsh side effects? What are the probabilities of successful
treatment? How do you measure the positive or negative
dimensions of the outcome? And what happens when you
multiply the probabilities against the outcomes?

But whatever we think about these questions, that poorly
written article won't shed much light on the problem.

Alan