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Adding Radiation Therapy For Treatment of Advanced Prostate Cancer May Offer Benefit

Treating advanced prostate cancer with radiation therapy after removal of the prostate gland reduces //the risk of disease recurrence, but does not appear to significantly improve the length of survival, according to a study in the November 15 issue of JAMA, a theme issue on men's health.

Gregory Swanson, M.D., of the University of Texas Health Science Center, San Antonio, presented the findings of the study today at a JAMA media briefing on men's health in New York.

Radical prostatectomy (removal of the prostate gland) is selected for treatment of localized prostate cancer by approximately one-third of the 230,000 patients newly diagnosed each year in the United States. It is commonly accepted that this treatment has optimal results in patients with cancer confined to the prostate. But cancer outside of the prostate is detected at radical prostatectomy in 38 percent to 52 percent of patients, and this is associated with a risk of disease recurrence, progression, and death, according to background information in the article. Adding (adjuvant) radiation therapy to treatment has been used for more than 4 decades to reduce the risk of disease recurrence, but it is unknown if this reduces the risk of the cancer spreading or improves survival.

Dr. Swanson and colleagues conducted a study comparing usual care with adjuvant radiation therapy for 425 men with cancer outside of the prostate after radical prostatectomy to determine the effect on metastasis-free survival and overall survival. The patients were enrolled between August 1988 and January 1997, with median (midpoint) follow-up of 10.6 years. Men were randomly assigned to receive external beam radiotherapy (n = 214) or usual care plus observation (n = 211).

A total of 43.1 percent of the patients in the observation group were diagnosed with metastatic disease or died (median metastasis-free estimate, 13.2 years) vs. 35.5 percent of the patients in the adjuvant radiothera
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