Prostate Cancer Treatment (PDQ®)–Health Professional Version

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Changes to This Summary (03/31/2017)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Treatment Option Overview for Prostate Cancer

Revised text to state that the more convenient schedules of hypofractionated radiation therapy appear to yield similar outcomes to conventional schedules of radiation, at least with respect to the intermediate outcomes of disease-free survival, failure-free survival, and early data on overall survival (OS) rates.

Added Dearnaley et al. as reference 66. Also stated that the Hypofractionated High-Dose Intensity Modulated Radiotherapy in Prostate Cancer or CHHIP trial was designed as a noninferiority study. Added statistics about the primary endpoint, failure-free survival rates, overall mortality rates, and the results of a quality-of-life substudy with a patient-reported outcome.

Added Incrocci et al. as reference 68. Also stated that in the Hypofractionated versus Conventionally Fractionated Radiotherapy for Patients with Prostate Cancer or HYPRO study, the median follow-up was 60 months. Added statistics about the primary endpoint, relapse-free survival (cited level of evidence 1iiD) and overall 5-year survival in the two arms (cited level of evidence 1iiA).

Added text about a systematic evidence review that compared nonsteroidal antiandrogen monotherapy with surgical or medical castration from 11 randomized trials in 3,060 men with locally advanced, metastatic, or recurrent disease after local therapy. Also added that the use of nonsteroidal antiandrogen as monotherapy decreased OS and increased the rate of clinical progression and treatment failure (cited Kunath et al. as reference 96 and level of evidence 1iiA).

Stage III Prostate Cancer Treatment

Added text about the evidence for nonsteroidal antiandrogen monotherapy versus surgical or medical castration and cited a systematic evidence review that compared nonsteroidal antiandrogen monotherapy with surgical or medical castration from 11 randomized trials in 3,060 men with locally advanced, metastatic, or recurrent disease after local therapy. Also added that the use of nonsteroidal antiandrogen as monotherapy decreased OS and increased the rate of clinical progression and treatment failure (cited Kunath et al. as reference 33 and level of evidence 1iiA).

Stage IV Prostate Cancer Treatment

Added text to state that a systematic evidence review and meta-analysis of randomized trials in hormone-sensitive metastatic prostate cancer summarizes these data (cited Vale et al. as reference 39).

Added text to state that in the analysis of three randomized trials, the hazard ratio of death associated with the addition of docetaxel to standard of care was 0.77, representing an absolute improvement of 9% in 4-year survival (cited level of evidence 1iiA).

Recurrent Prostate Cancer Treatment

Added text to state that a randomized trial has shown improved OS and prostate cancer-specific survival with the addition of high-dose bicalutamide to radiation therapy compared with radiation therapy alone in men with locally recurrent prostate cancer after radical prostatectomy (cited Shipley et al. as reference 5). Also added that in the trial, 760 men with a radical prostatectomy for tumor stage T2 or T3, a detectable prostate-specific antigen (PSA) level within a range, and no evidence of metastases, were randomly assigned to receive radiation and either bicalutamide or placebo for 24 months. Added statistics about median intervals from surgery to PSA detectability and from surgery to randomization, citing the median follow-up time; the statistics for the actuarial OS (cited level of evidence 1iA) and prostate cancer-specific mortality at 12 years (cited level of evidence 1iB) were stated. Most treatment-related toxicities were similar between the two groups, with the exception of gynecomastia, a side effect that may be mitigated by prophylactic breast irradiation.

Added text to state that some patients can be salvaged with prostatectomy after a local recurrence after definitive radiation therapy (cited Moul et al. as reference 6); in patients with local relapse, prolonged disease control is often possible with hormonal therapy (cited Schellhammer et al. as reference 7).

Added Nonsteroidal antiandrogen monotherapy versus surgical or medical castration as a new subsection.

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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