Brachytherapy Combined With or Without Hormone Therapy for Localized Prostate Cancer.

[pjoshea13]

New meta-analysis below [1].

As expected:

brachytherapy "combined with {hormone therapy} can increase the {biochemical progression-free survival} rates of patients with localized prostate cancer, but it does not improve patients' {overall survival} rates."

One cannot assume that when a new drug, say, is reported to improve 5-year biochemical progression-free survival, that this is good news for overall survival.

It has been argued that it is a good thing for a treatment to shunt some men towards an alternative death. Who wants to die of PCa? I expect more from a therapy. What happened to "do no harm” (primum non nocere)?

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/321...

Front Oncol

, 10, 169 2020 Feb 19 eCollection 2020

Brachytherapy Combined With or Without Hormone Therapy for Localized Prostate Cancer: A Meta-Analysis and Systematic Review

Xueliang Zhou 1 , Dechao Jiao 1 , Mengmeng Dou 2 , Jianjian Chen 1 , Bin Han 3 , Zhaonan Li 1 , Yahua Li 1 , Juanfang Liu 1 , Xinwei Han 1

Affiliations expand

PMID: 32140449 PMCID: PMC7042206 DOI: 10.3389/fonc.2020.00169

Abstract

Purpose: The purpose of this study was to evaluate the efficacy of brachytherapy combined with or without hormone therapy in patients with localized prostate cancer. Methods and Materials: We systemically searched the Medline, Web of Science, Cochrane Library and Embase databases for studies published between the databases' dates of inception and February 2019. The primary endpoints were the 5-year overall survival (OS) rates, 5-year biochemical progression-free survival (bPFS) rates and 10-year bPFS rates. The results were expressed as the relative risk (RR) and 95% confidence interval (CI). Based on the heterogeneity evaluated with the I 2 statistic, a meta-analysis was performed using either a random- or fixed-effects model. Results: A total of 16 cohort studies including 9,359 patients met all the criteria for inclusion in the analysis. Our data showed that brachytherapy (BT) combined with hormone therapy (HT) increased the patients' 5-year bPFS rates (RR = 1.04, 95% CI: 1.01-1.08, P = 0.005) and 10-year bPFS rates (RR = 1.12, 95% CI: 1.02-1.23, P = 0.001) compared with BT monotherapy. However, BT combined with HT did not increase the patients' 5-year OS rates (RR = 1.02, 95% CI: 0.99-1.095, P = 0.1) compared with BT monotherapy. Conclusions: BT combined with HT can increase the bPFS rates of patients with localized prostate cancer, but it does not improve patients' OS rates.

Keywords: brachytherapy; hormone replacement therapy; meta-analysis; prostate cancer; survival.

Copyright © 2020 Zhou, Jiao, Dou, Chen, Han, Li, Li, Liu and Han.

[timotur]

This study is inherently flawed: mono-BT is for lower risk patients, and BT+ADT for more advanced risk, so saying O/S declines on ADT doesn't consider that important difference in the two groups.

[GP24]

Dr. Stone found in a prospective study that low testosterone levels after brachytherapy reduce the survival by about one year and therefore recommends no ADT with brachytherapy:

auajournals.org/doi/full/10...

[timotur in reply to GP24]

Again this study doesn’t stratify the Brachy population acc to risk... Brachy with no ADT is likely a lower risk group than Brachy with ADT, thus longer O/S.

[Grumpyswife]

My husband got caught up in this disagreement when he had brachytherapy. The RO who did the BT wanted no ADT in order to monitor the PSA response. Our local RO insisted on a 90 day shot of Lupron before BT to “shrink the tumor” which masked the results making it look successful for a few months. It wasn’t successful for him. Soon after the Lupron cleared metastasis were found in the lungs.

[j-o-h-n in reply to Grumpyswife]

Your local guy RO is a Rotten Oncologist.....may he suffer the slings and arrows of outrageous fortune.... and may your husband try Keytruda for his lung metastasis (and it works)....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/07/2020 12:57 PM EST

[Grumpyswife in reply to j-o-h-n]

The local "guy" RO is female.

What are the SEs for you? QOL is very important to my husband now. Yesterday he mentioned getting off of some of the pills. Of all the doctors we’ve seen not one has ever mentioned Keytruda.

[j-o-h-n in reply to Grumpyswife]

Sorry but may Ms. Doctor....get it in the end... No Side Effects for me while on Keytruda...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/08/2020 5:49 PM EDT