Warde noted that while men had the predicted side effects of hormone therapy, such as erectile dysfunction, hot flashes and mood swings, the addition of radiation did not affect overall quality of life three years after treatment.
When the study began in 1995, the protocol was to use hormone therapy for life, and radiation was given in lower doses, but not as precisely directed as it is today, Warde said. Currently, hormone therapy is used for a shorter time, usually two to three years, and radiation is given in higher doses but more specifically targeted to the tumor.
"There is reason to think that with modern radiation approaches that the results would be much better," he said.
Prostate cancer expert Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said that "this doesn't change practice, because we already do this, but it's a validation that you cannot leave out one or the other treatment when treating someone with locally advanced disease."
Dr. Matthew R. Cooperberg, an assistant professor of urology at the University of California, San Francisco, and author of an accompanying journal editorial, said that "high-risk disease needs to be treated aggressively."
However, this study doesn't determine what is the best treatment for high-risk prostate cancer, Cooperberg said. "There are studies showing that the best treatment for high-risk disease starts with surgery and then radiation and hormones as necessary," he noted.
"Men with high-risk disease need multi-modal therapy," Cooperberg said. "Whether the approach should be surgery possibly followed by radiation, is still the big open question that we need to answer."
These patients are not candidates for what is called active surveillance, where doctors wait for the disease to adv
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