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Prostate Cancer Treatment (PDQ®)

Health Professional Version

Changes to This Summary (10/28/2014)

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.

Treatment Option Overview for Prostate Cancer

Added text to state that hormone therapy is a treatment option for recurrent prostate cancer.

Revised text to update a randomized clinical trial performed in Sweden in the preprostate-specific antigen (PSA)–screening era that studied radical prostatectomy versus watchful waiting; about 5% of the men in the trial had been diagnosed by PSA screening (cited Bill-Axelson et al. as reference 30); the cumulative overall mortality at 18 years in the radical prostatectomy study arm was 56.1% and 68.9% in the watchful waiting study arm; and the cumulative incidence of prostate cancer deaths at 18 years was 17.7% versus 28.7%.

Added Wilt as reference 32.

Added Dearnaley et al. as reference 60.

Added text to state that the MRC-RT01 study was powered to detect differences in both biochemical progression-free survival (PFS) and a 15% difference in overall survival (OS), 843 men with stage T1b through T3a, N0, M0 prostate cancer were randomly assigned to receive 64 Gy in 32 fractions versus 74 Gy in 37 fractions by conformal delivery. Also added that men in both study groups received neoadjuvant luteinizing hormone-releasing hormone agonist injections every 4 weeks for 3 to 6 months before the start of radiation and throughout the radiation course.

Added text to state that a randomized trial of 121 men with intact erectile function compared daily preventive tadalafil with placebo for 24 weeks beginning at the start of either external-beam radiation or brachytherapy (cited Pisansky et al. as reference 72 and level of evidence 1iC). Also added that there were no statistically significant differences in spontaneous erectile function or any other measures of sexual function.

Stage II Prostate Cancer Treatment

Revised text to include evidence about radical prostatectomy compared with watchful waiting in a clinical trial of 695 randomly assigned men with prostate cancer in Sweden in the pre-PSA screening era (cited Bill-Axelson et al. as reference 16). Also revised statistics about the cumulative overall mortality and the cumulative incidence of prostate cancer deaths at 18 years in the radical prostatectomy and watchful waiting study arms (added level of evidence 1iiA).

Added Wilt as reference 18.

Stage IV Prostate Cancer Treatment

Added text to state that newer hormonal approaches, such as inhibition of androgen receptors, have been shown to improve overall OS and quality of life after tumor progression despite androgen deprivation therapy.

Revised text to state that when used as the primary therapy for patients with stage III or stage IV prostate cancer, androgen suppression with hormonal therapy is often given continuously until there is disease progression. Also added that another option is intermittent androgen suppression as a strategy to attain maximal tumor cytoreduction followed by a period without therapy to allow treatment-free periods.

Added text to state that CALGB-90202 was a randomized controlled trial that compared zoledronic acid with placebo in 645 men with androgen deprivation-sensitive prostate cancer that was metastatic to bone; patients who progressed on hormone-therapy resistance received open-label, zoledronic acid (cited Smith et al. as reference 42 and level of evidence 1iDiii). Also added that between the two study arms, there was no difference in risk with the primary endpoint of time to skeletal-related events after up to 7 years of follow-up; there were also no differences in PFS or OS.

Recurrent Prostate Cancer Treatment

Added text to state that 852 men with locally advanced or metastatic prostate cancer were enrolled and received androgen deprivation therapy (ADT) for 24 weeks (cited Salonen et al. as reference 17). The 554 patients whose initial 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 androgen deprivation (CAD) therapy. Also added that there were no statistically significant differences in outcomes in the intermittent androgen deprivation versus CAD study groups in median follow-up after 65 months (added level of evidence 1iiA).

Added text to state that because there are no head-to-head comparisons, there are no trials to help decide which of these agents should be used first or in what sequence.

Added Smith et al. as reference 38.

Added text to state that a randomized placebo-controlled trial included 1,432 men with castration-resistant prostate cancer with no evidence of any metastases who were given denosumab to prevent the first evidence of bone metastasis (Level of evidence: 1iDiii). Also added statistics about median bone metastasis-free survival after a median follow-up of 20 months. Also added that symptomatic bone metastases were reported in more denosumab patients than placebo patients, but no differences were found in OS between the two groups; additional statistics include the occurrences of osteonecrosis, hypocalcemia, and urinary retention in men on denosumab versus placebo.

Added text to state that hormone therapy is a treatment option for recurrent prostate cancer.

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.

  • Updated: October 28, 2014