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Thalidomide, Radiotherapy Compared to Reduce Risk of Metastases Following Prostatectomy NEW YORK -- January 22, 2009 -- Two studies published in the March issue of The Journal of Urology report on treatment options for recurrence of cancer after prostate surgery. In the first study, William D. Figg, Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Rockville, Maryland, and colleagues investigated the addition of thalidomide to intermittent androgen deprivation therapy (ADT) in a double-blind, placebo-controlled, multicentre study. Patients were first given ADT for 6 months, followed by thalidomide or placebo until their prostate-specific-antigen (PSA) increased (Oral Phase A). Researchers found that the median time to PSA increase was 15 months for the thalidomide patients versus 9.6 months for placebo. The next phase, Oral Phase B, was another 6 months of ADT followed by thalidomide and placebo, now switched between patient groups. During this phase, the median time to PSA increase was 17.1 months for thalidomide and 6.6 months for placebo. "Thalidomide is associated with an increase in PSA progression-free survival in men with biochemically recurrent prostate cancer after intermittent ADT," said Dr. Figg. "These effects were independent of any effects on testosterone. This is the first study to our knowledge to demonstrate the effects of thalidomide using intermittent hormonal therapy." In the second study, Ian M. Thompson, MD, University of Texas Health Science Center, San Antonio, Texas, and colleagues demonstrate that adjuvant radiotherapy significantly improves survival after radical prostatectomy in patients with advanced prostate cancer. The study, initiated in 1988, included 425 men with aggressive prostate cancer of which 211 were observed after surgery for signs of recurrence and 214 received adjuvant radiotherapy shortly after surgery. Unlike most studies, which have based results on PSA recurrence, this study's endpoint was development of metastatic disease. When data were most recently evaluated in 2008 after an average 12.7 years follow-up, radiation was found to significantly reduce the risk of metastases by 29% and significantly improved survival by 28%. In addition to the most important outcomes of prostate cancer, the risk of a detectable PSA after surgery was reduced by 58% and delayed by more than 7 years. The authors found that all risk groups studied appeared to benefit. Radiation therapy also significantly reduced the need for hormone therapy after surgery. Using measures of quality of life, the study found increases in patients' urinary and bowel symptoms in the radiotherapy group at 6 weeks and 2 years, but these differences subsequently disappeared. "Adjuvant radiotherapy within 18 weeks after radical prostatectomy in a man with pT3N0M0 prostate cancer significantly reduces the risk of PSA recurrence, metastasis, the need for hormonal therapy, and significantly increases survival," said Dr. Thompson. SOURCE: Elsevier Health Sciences E-mail this page to a friend or colleague! To print, use this version