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Prostate cancer treatment news

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A new way of giving existing prostate cancer treatment can reduce side effects and improve quality of life.

A new study into treatment for prostate cancer has some promising news for men affected by this condition. The findings have shown that changing the way one treatment is given doesn’t affect survival, and helps patients by reducing side effects.

The UK section of this international trial was funded by Cancer Research UK and led by The Institute of Cancer Research, London. This phase 3 trial involved almost 1,400 men who had already received radiotherapy treatment, which had failed to clear their cancer.

The patients were divided into two groups. One group received an existing hormone therapy drug continuously, which is the standard current treatment. The other group was given the same hormone therapy drug, but treatment was stopped after eight months. This group’s doctors checked their prostate specific antigen (PSA) levels every two months. (PSA is a protein. If you have high levels of PSA it can mean that you have cancer if you haven’t already been diagnosed. In this case the PSA test indicated whether the hormone treatment needed to be re-started.) The men in the study were followed up for an average of around seven years.

When a patient’s PSA level reached a certain level (10 ng per millilitre), their hormone treatment began again, for another eight months. This cycle of eight-monthly treatment interspersed with breaks continued until the end of the treatment.

The results from this trial showed that taking hormone therapy intermittently, rather than continuously, didn’t make a difference to the patients’ length of survival. However, the study did show potential benefits when it came to side effects. The group that received intermittent treatment reported fewer urinary problems and hot flushes, improved sex drive and ability to have an erection.

Prostate cancer cells

Prostate cancer cells

UK chief investigator Professor David Dearnaley, professor of uro-oncology at The Institute of Cancer Research and honorary consultant at The Royal Marsden NHS Foundation Trust, said: “This large-scale trial has shown that periodically stopping men’s hormone therapy can give them fewer side-effects without reducing their clinical survival, and should lead to a change in clinical practice.

“More than 10,000 men are treated with potentially curative radiotherapy for prostate cancer each year in the UK and so our findings have the potential to benefit thousands of men.


“It would be possible for specialist oncologists and urologists to implement this treatment strategy straight away for individual patients. Many oncologists, in fact, will have been using this approach already.

“The monitoring of the intermittent or ‘stop-start’ approach is a little more complicated than the more standard method of continuous hormone therapy with androgen suppression which, in many instances, will be monitored by general practitioners. Monitoring using continuous hormone therapy is quite simple and based on PSA levels (which should be low) and clinical symptoms. Referral back to a specialist is only required if the PSA level rises.

“In practice, the ‘stop-start’ approach may be more difficult for many General Practitioners to manage. This has the implication that more patients would need to be followed by specialist oncologists and urologists which would alter the patterns of care and ‘patient pathways’ in many areas.” Professor Dearnaly pointed out that any savings from the reduced use of hormone therapy (which costs approximately £100/month) would need to be balanced against the increased cost of more frequent specialist monitoring when using the intermittent ‘stop-start’ approach.

“It is very important to manage men with prostate cancer recurrence of this type on an individual basis,” added Professor Dearnaly. “For those who have significantly troublesome symptoms from hormonal therapy, the intermittent approach will be very attractive. Many men, however, have very little in the way of side effects from androgen suppression (hormone therapy), and for these individuals intermittent therapy may offer very little advantage and such men may prefer the easier monitoring with a continuous treatment approach.”

“Results such as these highlight the value of clinical trials,” says Kate Law, Cancer Research UK’s director of clinical research. “Refining treatment to reduce side-effects and improve the outcome for patients remains the key goal. And being able to reduce the side-effects of prostate cancer treatments from currently available treatments offers patients and their doctors the potential of a new option of how their treatment is delivered.”

Prostate cancer and PSA testing

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While a raised PSA level may indicate that a man has prostate cancer, it is not conclusive so can result in unnecessary treatment.

PSA (prostate specific antigen) tests have been used to screen men for prostate cancer for many years but lately the procedure has been criticised. Some studies indicated that raised PSA levels were not a good indicator of aggressive types of prostate cancer and in the US, where routine PSA blood tests for men over 50 were the norm, researchers have suggested that the practice could lead to unnecessary treatment.

Recently, the US Preventative Services Task Force even went so far as to advise against offering PSA screening. The reason? PSA screening, it’s argued, might lead doctors to treat men who did not need it but would then have to suffer some of the unpleasant side effects (incontinence, erectile dysfunction). Here in the UK, men are not offered PSA tests as a routine but only if they request it or have symptoms.

However, in light of these criticisms, some have begun to question the value of PSA testing altogether. A new analysis of data from researchers at the University of Rochester Medical Center in New York has looked at what would happen if doctors were to stop PSA testing. They looked at data from a time when PSA testing was done less routinely than today, and compared it to current data when testing is standard.

Prostate cancer cells

Prostate cancer cells

The results make for grim reading. Doing away with the test completely would likely result in a three-fold increase in the development of advanced-stage prostate cancer, meaning that the cancer would have spread to other parts of the body before diagnosis. Once the cancer has spread to other parts of the body is it obviously far more difficult – sometimes impossible – to treat. The researchers concluded that PSA testing and therefore, early detection, helps approximately 17,000 men in the US alone avoid advanced cancer every year.


These results, however grim-sounding, need to be put into context. PSA testing, when applied to men who do not have aggressive tumours, can lead to non-essential treatment and with it, unpleasant side effects. However, PSA testing when applied to men who have a more aggressive form of the disease can be life-saving because in these cases, if the tumour is removed before it has a chance to spread, the man will most likely survive; if the cancer spreads, his risk of death or at least of more invasive treatment, is raised dramatically.

But the main problem is that high PSA levels do not necessarily indicate cancer, and even when they do, it may not be an aggressive cancer. As with any medical test results, PSA levels need to be taken in context. High levels on their own do not indicate cancer, but taken with the results of a digital rectal exam, and any other signs or symptoms a man may have, they do point to a risk of cancer. Relying on one PSA test, however, could lead to men getting unnecessary treatment as levels may fluctuate. A recent urinary tract infection or an enlarged prostate can cause levels to rise, as can ejaculating before a test. So always ask to have your PSA levels checked twice.