Men with prostate cancer do not need radiotherapy after surgery

In a new study, researchers found men with prostate cancer can be spared radiotherapy after surgery.

The results suggest that radiotherapy is equally effective whether it is given to all men shortly after surgery or given later to those men with recurrent disease.

The study answers a longstanding question about whether the benefits of radiotherapy after surgery outweigh the side-effects.

The research was conducted by a team from The Royal Marsden NHS Foundation Trust and elsewhere.

RADICALS-RT is the largest ever trial of postoperative radiotherapy in prostate cancer. It enrolled 1,396 patients after surgery for prostate cancer from the UK, Denmark, Canada, and Ireland.

Men were randomly allocated to postoperative radiotherapy or the standard approach of observation only, with radiotherapy kept as an option if the disease recurred.

It found no difference in disease recurrence at five years between men who routinely had radiotherapy shortly after surgery and men who had radiotherapy later if cancer came back.

There is a strong case now that observation should be the standard approach after surgery and radiotherapy should only be used if cancer comes back.

The team says the good news is that in future, many men will avoid the side-effects of radiotherapy.

These include urinary leakage and narrowing of the urethra, which can make urination difficult. Both are potential complications after surgery alone, but the risk is increased if radiotherapy is used as well.

These are the first results to suggest that postoperative radiotherapy for prostate cancer could be omitted or delayed in some patients.

This will shorten the duration of treatment for these patients and allow better use of resources since today’s radiotherapy is technically sophisticated and therefore expensive.

However, strict follow-up will be needed to identify patients requiring salvage radiotherapy.

The lead author of the study is Prof Chris Parker from The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.

The study was presented at the ESMO Congress 2019 in Barcelona, Spain.

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