Cure in Prostate Cancer Patients

I read with interest the article by Hanks andcolleagues—and the reviews that followed—on the evidence for cure inprostate cancer.[1] The data were encouraging, and the concepts raised werestimulating. Any discussion of tumor control and patient cure in prostate cancerinevitably refers to prostate-specific antigen (PSA) control. The 5-, 10-, and15-year posttreatment PSA level is worthy of debate.

In discussing cure in prostate cancer patients, the minimum definition shouldbe clinical control at the time of death. The maximum designation would be PSAcontrol at death. Not many clinicians and patients are interested in the risk ofcancer failure after death. This is important because 40% to 60% of men will dieof non-cancer-related causes in the 10 to 15 years following treatment ofprostate cancer. The article does not report mortality from prostate cancerfollowing external radiation. The surgical literature suggests that the averagetime to cancer death after PSA failure is 13 to 15 years.

PSA and Local Treatment

Another point of interest centers on the risk of PSA failure more than 3years after treatment. PSA relapse is reduced with appropriate local treatment—eg,prostatectomy, two-dimensional radiation therapy, three-dimensional conformalradiation therapy, dose escalation, intensity-modulated radiation therapy,implant, or a combination of these approaches. PSA failures related to localrelapse (and late metastases) may benefit from more aggressive local treatment.However, a major cause of PSA failure is related to metastatic disease alreadypresent at the time of local treatment. Hence, the rate of PSA failure may berelated to patient and tumor selection rather than the effectiveness of thelocal treatment.

GILBERT LAWRENCE, MD, DMRT, FRCR
Regional Cancer Center, Radiation Oncology, 
Faxton-St. Luke’s Healthcare,Utica, New York

References:

1. Hanks GE, Hanlon AL, Horitz EM: Evidence for cure of ‘young’ men withprostate cancer. Oncology 15(5):563-574, 2001.