Changes to This Summary (02/14/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2014 (cited American Cancer Society as reference 15).
Added Zlotta et al. as reference 7.
Added text to state that conventional hypofractionation was not found to be superior to conventional fractionation in a small, randomized trial of 303 assessable men who received conventional intensity-modulated radiation therapy (IMRT) versus hypofractionated IMRT. Added that the primary endpoint was biochemical or clinical disease failure. Also added that there were no statistically significant differences in the secondary endpoints, though the mortality rates were low, and the trial was underpowered for mortality endpoints (cited Pollack et al. as reference 58 and level of evidence 1iiDiii).
Added Alpha emitter radiation as a new subsection.
Added Nam et al. as reference 67. Also revised text to state that external-beam radiation therapy for prostate cancer is associated with an increased risk of bladder and gastrointestinal cancer.
Added Wilt as reference 15.
Added text to state that in another study, 852 men with locally advanced or metastatic prostate cancer were enrolled and received androgen deprivation therapy (ADT). The 554 patients whose initial prostate-specific antigen (PSA) decreased to less than 10 ng/ml or by more than 50%, if initial PSA was greater than 20 ng/ml, were randomly assigned to an open-label strategy of intermittent ADT or to continuous ADT. Also added the outcomes in the intermittent androgen deprivation (IAD) versus the continuous androgen deprivation (CAD) therapy study groups at the 65-month median follow-up and stated that none of these differences were statistically significant (cited Salonen et al. as reference 40 and level of evidence 1iA).
Added text to include continuous ADT plus chemotherapy for metastatic disease as a treatment option under clinical evaluation. Added that the addition of chemotherapy to ADT at the first documentation of metastatic disease has not been shown to improve survival compared with the initiation of effective chemotherapy at the onset of ADT resistance. Also added that in a trial of 385 men with metastatic disease, patients were randomly assigned to receive ADT with or without docetaxel, with the option to add docetaxel in the ADT-alone study arm at progression; overall survival (OS) on both study arms was similar. Hematologic toxicity and quality of life was worse in the ADT-plus-docetaxel study arm while patients were receiving docetaxel (cited Gravis et al. as reference 51 and level of evidence 1iiA). Studies about the early addition of other active agents to ADT are warranted (cited Sweeney as reference 52).
Added text to state that a systematic evidence review and meta-analysis identified nine randomized, controlled trials of varying quality that addressed the issue of the addition of chemotherapy. Added that more than 5,000 men with increasing PSA after local treatment or with locally advanced or metastatic prostate cancer were randomly assigned to receive IAD therapy versus CAD therapy if they had met the criteria of a satisfactory decline in serum PSA on initial androgen therapy. Among 4,101 men for whom OS data were available, there was no statistically significant difference for IAD versus CAD (cited Niraula et al. as reference 16 and level of evidence 1iiA) There was also no statistically significant difference in the three studies that were reporting time to progression (cited Niraula et al. as reference 16 and level of evidence 1iiDii).
Added text to state that a 2-weekly regimen of docetaxel has been compared with a 3-weekly regimen. OS appeared to be better in the 2-week regimen, and hematologic toxicity was less. Added that 361 men with metastatic hormone-resistant prostate cancer were randomly assigned to receive docetaxel either in a 2-weekly regimen or a 3-weekly regimen until progression. Also added that with a median follow-up of 18 months, there was a small difference in time-to-treatment failure, the primary endpoint of the study; however, there was a larger difference in median OS in favor of the 2-week regimen; there was a lower rate of grade 3 to 4 neutropenia with the 2-week regimen and a lower rate of febrile neutropenia (cited Kellokumpu-Lehtinen et al. as reference 41 and level of evidence 1iiA).
Added Alpha Emitter Radiation as a new subsection.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.