Trimodal approach to prostate cancer promising

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In patients with locally advanced Prostate cancer, a three-pronged approach to therapy can achieve a high level of tumor control, researchers at the University of Virginia in Charlottesville report.

The trimodal approach involves treatment with testosterone-blocking drugs coupled with implantation of tiny radioactive seeds in the prostate, a treatment called brachytherapy, and external beam radiation therapy.

Trimodality therapy “is an excellent treatment for patients with high-risk Prostate cancer and offers hope in patients with this life threatening cancer,” said senior investigator Dr. Dan Theodorescu.

From 3 to 5 years after initial treatment, these patients have a high likelihood of treatment failure, as evidenced by rising prostate-specific antigen (PSA) levels, Theodorescu and colleagues note in the June issue of Urology.

To examine whether the trimodal approach would extend survival, the researchers conducted a pilot study of 93 patients. Fifty-six patients were considered at high risk and the remaining 35 were deemed to be at intermediate risk.

The patients received 8 to 9 months of hormone-blocking drugs, followed by 2 to 3 months of external beam radiotherapy concluding with brachytherapy.

Patients were examined at regular intervals and median follow-up was 45 months.

At 4 years, the event-free survival rate was 85 percent for the intermediate-risk group and 79 percent in the high-risk group, which suggests that trimodal therapy “offers excellent tumor control in patients with poor prognosis who often relapse early,” the team concludes.

They emphasize, however, that longer follow-up “will be important to determine whether these results are durable over time.”

SOURCE: Urology June 2005.

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