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March 22, 2017

A faster way to treat prostate cancer is gaining traction—but some experts are skeptical

Daily Briefing

A short-course radiation therapy for prostate cancer is growing in popularity, despite a dearth of scientific data on how it compares to more traditional radiation therapy, Gina Kolata writes for the New York Times.

Standard radiation therapy for prostate cancer includes 40 sessions conducted over roughly two months or 28 sessions over five to six weeks. But patients increasingly are turning to a newer treatment, called stereotactic body radiation therapy (SBRT), that is "more intense" and can be completed in five sessions over a two-week period, Kolata writes.

Medicare data show the number of men who received SBRT increased from 716 in 2007 to 1,886 in 2013, while the number of men who received standard radiation therapy fell from 66,549 to 47,512 over the same time period.

Despite the treatment's growing popularity, some providers have concerns about suggesting the treatment, Kolata writes, because "no one knows whether it is as effective in curing prostate cancer, or how its side effects compare" with traditional treatment.

Dearth of data

While prostate cancer is the second-most common cancer in men—affecting 180,000 patients annually—Kolata writes that "treatments for lung cancer, and for other common cancers like those of the breast and colon, have been evaluated in randomized clinical trials more often than those for prostate cancer."

One reason for the lack of data is that prostate cancer typically grows slowly, meaning it can take several years—and a lot of funding—to determine whether a treatment saves lives, Kolata writes. Further, the treatments patients receive often change over a decade, causing doctors to question the relevance of research results.

Another reason past studies have failed, according to Kolata, is that "specialists were already convinced that the [treatment] method they used was best and were reluctant to assign men to other treatments."

The National Cancer Institute is working to address those concerns and recently agreed to fund a clinical trial that will compare SBRT with a traditional treatment. For the study, researchers will randomly assign 538 patients to receive either five sessions of radiation over two weeks or 28 sessions over five and a half weeks.

Researchers will compare participants' long-term quality of life as well as disease survival. But, according to Kolata, it will take at least eight years for the trial to yield answers.

James Yu—a radiation oncologist at Yale Cancer Center, who will lead the quality of life assessment for the new clinical trial—said key questions surrounding the new treatment that the study hopes to answer are, "How fast can you give it and how fast is too fast?"


But until those questions are answered, providers must continue to navigate treatment option discussions with their patients, Kolata writes.

Genetic test predicts treatment failure for prostate cancer

Anthony D'Amico, a radiation oncologist at Brigham and Women's Hospital and the Dana Farber Cancer Institute, noted that the prostate is near the bladder neck, rectum, and urethra, which can be damaged by intense radiation. However, those injuries could take up to five or 10 years to surface, he said.

When patients ask about the newer treatment, Daniel Lin, chief of urologic oncology at the University of Washington, said he tells them, "It probably can work but it doesn't have long-term results and it hasn't been tested against standard radiation."

At centers such as Sloan Kettering Memorial Cancer Center, doctors are relying on in-house data to determine whether to recommend the new treatment. Michael Zelefsky, a radiation oncologist who treats patients at Sloan Kettering, said the center has had several hundred men receive the short-course treatment over the past three years and those patients' outcomes suggest the treatment "is emerging as a very exciting form of therapy" (Kolata, New York Times, 3/20).

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