Hope for radiation-free prostate cancer care

Prostate cancer occurs in the prostate — a small walnut-shaped gland in men that produces seminal fluid, which nourishes and transports sperm. FILE PHOTO | NMG 

By SARAH OOKO
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Prostrate is the leading type of cancer affecting men in Kenya, just as is the case in many countries.

The most up todate statistics from the World Health Organisation’s GLOBOCAN report shows that
close to 3,000 (2,864) men are diagnosed with the condition each year in the country.

To effectively tackle the disease and increase survival chances, prompt diagnosis and treatment of the condition is recommended.

Treatment involves surgery (to remove the tumour) and thereafter radiotherapy (to kill cancer cells that may remain behind).

Irrespective of its benefits in cancer treatment, radiotherapy comes with adverse side effects – such as rectal bleeding and urinary leakage. This is always a cause of worry and concern for many patients.

Findings of a study presented at the recently concluded European Society for Medical Oncology (ESMO) offers some good news on how to approach prostrate cancer treatment.

The research trial, known as RADICALS-RT, enrolled 1,396 patients who had undergone surgery for prostate cancer from the United Kingdom (UK), Denmark, Canada and Ireland.

Some of the men were subjected to post-operative radiotherapy. The others were put under observation, with radiotherapy kept as an option, only if the disease recurred.

After a five-year follow up, the results demonstrated that men with prostate cancer could be spared radiotherapy after surgery.

According to the study authors, the findings answer a long-standing question- whether the benefits of radiotherapy after surgery outweigh the side effects.

The research, which is the largest ever trial of post-operative radiotherapy in prostate cancer, found no difference in disease recurrence - at five years - between men who routinely had radiotherapy shortly after surgery and those who had radiotherapy later, if the cancer came back.

"The results suggest that radiotherapy is equally effective whether it is given to all men shortly after surgery or given later with recurrent disease.

There is a strong case now that observation should be the standard approach after surgery and radiotherapy should only be used if the cancer comes back," said Dr Chris Parker, the first author of the study from the Royal Marsden National Health Service (NHS) Foundation Trust, and the Institute of Cancer Research in the UK.

He stated: "The good news is that in future, many men will avoid the side-effects of radiotherapy. These include urinary leakage and narrowing of the urethra, which can make urination difficult. Both are potential complications after surgery alone, but the risk is increased if radiotherapy is used as well."

According to the researchers, the study provides greater evidence to support the routine use of observation and early salvage radiotherapy (done only if the disease reoccurs) for prostrate cancer patients.

“It provides the best opportunity to assess whether adjuvant radiotherapy may still have a role in some groups of men, and to investigate longer term outcomes," stated Dr Claire Vale at the Medical Research Council Clinical Trials (MRC) Unit at the University College London in the UK.

"These are the first results to suggest that post-operative radiotherapy for prostate cancer could be omitted or delayed in some patients. This will shorten the duration of treatment for these patients and allow better use of resources since today's radiotherapy is technically sophisticated and therefore expensive,” stated Dr Xavier Maldonado, one of the researchers from the Hospital Universitari Vall d'Hebron at Barcelona in Spain.

He, however, noted that strict follow-up would be needed to identify patients requiring salvage radiotherapy, should the cancer come back again after surgery.

Regarding the need for future research, Dr Maldonado said the focus should be on how to pinpoint which patients still require adjuvant radiotherapy (immediately after surgery) to avoid a very early local relapse and potential subsequent spread of the disease.

"We need to develop genomic classifiers to help decide the best management strategy for each patient - whether it should include surgery and/or radiotherapy, and at which time points," he said.

Prostate cancer occurs in the prostate — a small walnut-shaped gland in men that produces seminal fluid, which nourishes and transports sperm.

Symptoms of the disease do not usually appear until the gland is large enough to affect the tube that carries urine from the bladder out of the penis (urethra).

When this happens, those affected will notice symptoms such as an increased need to urinate, straining while passing urine and a feeling that the bladder was not fully emptied after visiting the toilet.

Men with a father, son or brother who has suffered from prostate cancer have an increased chance of getting the disease. Those with two close relatives on the same side of the family who have suffered from the cancer could also inherit genetic changes that make them prone to the disease.

Despite the low risk, men without relatives who have suffered from the condition can still get prostrate cancer.

While some types of prostate cancer grow slowly and may need minimal or even no treatment, others are aggressive and can spread quickly.

But if the disease is detected early — while still confined to the prostate gland — chances of successful treatment are increased.