Nearly 40 percent of men in England and Wales with locally advanced metastatic prostate cancer, or those at high risk of having this condition, may not be getting proper therapy, according to a study by the National Prostate Cancer Audit (NPCA).
Instead of receiving radiotherapy or surgery, a considerable percentage of men are offered hormonal treatments without additional radiotherapy or surgery, which is considered to be an under-treatment for advanced prostate cancer. Doctors presented these findings at last month’s European Association of Urology conference in London.
Prostate cancer is the most common male cancer, with around 400,000 new cases every year in Europe. Great Britain alone reported more than 46,000 new cases of prostate cancer in 2014, leading to more than 11,000 deaths.
“Our work shows that up to 40 percent of patients diagnosed with high-risk or locally advanced prostate cancer may not be receiving the best available treatments in combination with hormonal therapy,” the study’s lead researcher, Arun Sujenthiran, said in a news release. “Future work will explore reasons for this and will also follow the progress of these men to see if their survival has been affected as a result.”
Various treatments exist for locally advanced prostate cancer. Previous studies showed that radical treatments — which aim at curing prostate cancer and eliminating cancer cells from other tissues — combined with standard hormonal therapies improve survival in patients, compared to hormonal treatment alone.
The new study, carried out by a team of clinicians and data analysts, reviewed the 2014-15 records of the National Prostate Cancer Audit. Results showed that 61 percent of the 11,957 patients with locally advanced prostate cancer received some form of radical therapy besides hormone therapy.
Indeed, 42 percent men received radiotherapy (external beam radiotherapy), 18 percent were treated with surgery (radical prostatectomy), and 1 percent had radioactive seeds implanted in their prostrates — a method that allows radiation to be directly applied to the tumor. The remaining 39 percent received hormonal therapy alone, which may help delay cancer growth but does not completely eliminate prostate cancer.
“This study has demonstrated that in current practice many men do not have their high-risk prostate cancer treated by radical surgery or radiotherapy and hormones,” said Prasanna Sooriakumaran, urological consultant at the University College London Hospital. “The true reasons for this are unexplained and need further investigation to ensure that all men with this type of prostate cancer receive maximal curative therapy when it is clinically appropriate.”
Added Noel Clarke, NPCA’s urological clinical lead professor: “There is strong evidence that radiotherapy to the prostate combined with hormone therapy before and for a period after improves overall survival. The evidence for the use of surgery in this setting is less strong but some men are likely to benefit. We have limited evidence at present to show that surgery and hormone therapy is truly beneficial. Some healthy older men may be at risk of under-treatment. Further work is required to follow the long-term outcomes of these men but also to understand what factors contribute to some men in this cohort receiving radical treatment and others not.”