Prostate cancer breakthrough means thousands of men could avoid devastating chemotherapy

Thousands of men a year with advanced prostate cancer could avoid gruelling chemotherapy by combining radiotherapy and hormone therapy, a study reveals.

Targeting the radiotherapy to the sites where the cancer has spread can delay further progression of the disease and the need for subsequent treatments, such as chemotherapy, which can have significant impact on a person's quality of life, researchers say.

The trial demonstrated that the patients' cancer did not progress for an average of six months (6.4) and two fifths (40.1 per cent) of patients remained progression-free at 12 months.

The research was led by The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, and presented today at The European Society for Radiotherapy and Oncology (ESTRO) annual congress.

The Phase II trial is the first prospective trial to investigate the use of stereotactic body radiotherapy (SBRT) in patients with hormone-resisistant oligoprogressive prostate cancer.

Oligoprogressive cancer occurs when cells from the original tumour travel within the body to fewer than three sites, forming new tumours or lesions.

Currently, disease progression after hormone therapy treatment is taken as a sign that the cancer has become resistant to the treatment.

However, findings from the trial revealed that it may just be some tumours that are resistant, and if the tumours are treated with radiotherapy the rest of the cancer will still respond to hormone therapy.

In the national study, which took place in cancer centres across the UK, researchers investigated whether giving SBRT along with a type of hormone therapy, called androgen receptor targeted agents, to patients with oligoprogressive prostate cancer would delay the time it takes for their cancer to progress.

The patients in the study had advanced prostate cancer that was no longer responding to regular treatment.

They had no more than two new areas of cancer that had appeared while they were on two types of hormone therapy, after initially responding well to the treatment.

All the patients were treated with five or six treatments SBRT, which is painless and takes about 20-30 minutes for each treatment.

81 men received SBRT and most of them (67 per cent) had one oligoprogressive lesion. The areas treated were bone (59 per cent), lung (1 per cent), lymph node (32 per cent) and prostate (8 per cent).

At an average of 19.2 months, 53 (65 per cent) patients experienced progression of their disease; 32 (40 per cent) progressed within six months following SBRT treatment.

Median progression-free survival following SBRT was 6.4 months and 40 per cent of men had no evidence of cancer growth 12 months after treatment.

Researchers estimate around 2,000 to 3,000 men per year would meet the qualifying criteria above.

WHAT IS PROSTATE CANCER?

How many people does it kill? 

More than 11,800 men a year - or one every 45 minutes - are killed by the disease in Britain, compared with about 11,400 women dying of breast cancer.

It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain. 

In the US, the disease kills 26,000 men each year.

Despite this, it receives less than half the research funding of breast cancer and treatments for the disease are trailing at least a decade behind.

How many men are diagnosed annually?

Every year, upwards of 52,300 men are diagnosed with prostate cancer in the UK - more than 140 every day.   

How quickly does it develop? 

Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS. 

If the cancer is at an early stage and not causing symptoms, a policy of 'watchful waiting' or 'active surveillance' may be adopted. 

Some patients can be cured if the disease is treated in the early stages.

But if it is diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.

Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.

Tests and treatment

Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge. 

There is no national prostate screening programme as for years the tests have been too inaccurate.

Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.

Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.

But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not fool-proof. 

Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks. 

Anyone with any concerns can speak to Prostate Cancer UK's specialist nurses on 0800 074 8383 or visit prostatecanceruk.org