Prostate news article, September 2005
| DELAYS ON RECEIVING
RADIOTHERAPY AFTER A DIAGNOSIS OF PROSTATE CANCER DO AFFECT OUTCOME
FOR THOSE WITH HIGH RISK DISEASE
Nguyen PL, Whittington R, Koo S et al. Article in Cancer 2005; 103:2053-9. Reviewed by: Dr Charlotte Foley MA BMBCh MRCS |
The impact of a delay in initiating radiation therapy on prostate specific antigen outcome for patients with clinically localized prostate carcinoma.
With most cancers, diagnosis is swiftly followed by treatment, lest any delay gives the cancer more time to spread. Unlike most cancers, prostate cancer needn’t always be treated and is generally perceived as a slow growing disease. It is therefore not unusual for a number of weeks or months to elapse between diagnosis and treatment. Patients may need time to decide between treatments or logistical issues may intervene. It is understood that men who undergo prostatectomy more than three months after diagnosis do worse, especially if their cancer is an aggressive one. Now a corresponding study has asked whether a delay in radiotherapy influences its effectiveness.
The progress of 460 American patients with gland-confined prostate cancer was correlated with the time taken from diagnosis to irradiation. The median treatment delay was 2.5 months, varying from 0.27 to 25 months. Treatment delay did not affect the outcomes of those with low risk prostate cancer (defined as PSA <10 and a Gleason score <7 with clinically small volume disease), though a subtle effect cannot be ruled out. However those men with high risk disease who were delayed more than 2.5 months did do worse compared to their more swiftly treated counterparts. At 5 years only 39% of the former still had stably low PSA levels, compared to 55% of the latter.
Deferring treatment for only a few weeks can reduce the effectiveness of radiation treatment too. While a delay of 2.5 months was used here for statistical reasons, logically the risk must increase with any delay. A sense of urgency is necessary and treatment should commence as soon as possible, especially for patients with more aggressive cancers or where a cure is intended.