Major prostate cancer trial launched by Auck DHB

Major prostate cancer trial launched by Auckland District Health Board

A major New Zealand research initiative that will determine the best time for men with prostate cancer to receive radiation therapy after surgery to remove the prostate has been launched in New Zealand and Australia.

The trial, which is led by the Radiation Oncology Department at Auckland City Hospital, has been developed in collaboration with colleagues in both New Zealand and Australia.

“There are currently two ways of managing men who are at high risk of their cancer recurring after they have had surgery to remove their prostate,” says Auckland City Hospital radiation oncologist and trial chair Dr Maria Pearse.

“One is radiotherapy within four months of surgery and the second is to watch men very closely (active surveillance) with regular clinic visits and regular Prostate Specific Antigen (PSA) blood tests.”

What is not known at present is whether these two approaches are the same in controlling the cancer in the long term.

The aim of the study is to see whether patients managed with active surveillance (and giving radiotherapy when the PSA rises) is as good as immediate radiotherapy.

This study will also compare the side effects occurring in each treatment group and what effect the treatments have on quality of life.

“It would be simple to give everyone radiotherapy if there were no side effects but many men experience side effects such as urinary incontinence, permanent bowel changes and impaired sexual function”, says Dr Pearse.

“We know from prior studies that half of the men who have radiotherapy immediately after surgery will benefit from it, while the other half will not.

“It is therefore important to determine the best time for men to receive radiation therapy, as some men may be able to avoid unpleasant side effects that sometimes have a long lasting impact,” adds Dr Pearse. Because the best timing is not yet known, this trial has the potential to change clinical practice not only in New Zealand, but globally.”

The PSA blood test can detect activity of the cancer months or years before other tests and usually long before any symptoms appear. Radiotherapy is only given if the PSA starts to rise. In this situation nearly half the patients would be spared the possible side effects of radiotherapy.

To effectively test the hypothesis, a total of 470 patients are needed, which explains the need to extend participation in the study across the Tasman through collaboration with the Trans Tasman Radiation Oncology Group.

So far, 27 patients have volunteered, with recruitment expected to pick up quickly as more sites come on board. Recruitment will take place over the next four to five years, with the study continuing for a further five years after recruitment.

Auckland patient Mr David Woods was the first to enrol in the trial earlier this year. Since then, the trial has opened in 16 sites across New Zealand and Australia, with all regional cancer treatment centres in New Zealand agreeing to participate. A total of 35 hospitals are expected to join the trial.

Speaking about his involvement in the trial Mr Woods said, “I’m happy to take part if this trial can help men down the line. It’s great that I have this option. This research will help find the best treatment for men like me.”

The trial has successfully attracted funding from agencies such as the New Zealand Health Research Council, the Genesis Oncology Trust and the Australian National Health Medical Research Council.

Notes:

Criteria to participate in the study requires being at high risk of PSA rising again. This is determined by finding prostate cancer in one of the following areas:

• At the edges of the prostate gland and surrounding tissue that was surgically removed.
• Outside the capsule that encloses the prostate.
• In the seminal vesicles (the glands that sit above the prostate).

ENDS