Short hormonal therapy associated with extremely precise radiotherapy, or stereotassic. In this way, survival without progression of illness is doubled in patients with a prostate cancerwhen, years after initial treatment (surgery or radiotherapy), the disease reappears with few metastases. That is, if we talk about oligometastasi.
To propose this opportunity is a study by the European Institute of Oncology, just published in the Lancet Oncology magazine, which demonstrates the value of the combination of a brief hormonal therapy with the stereotassic radiotherapy. The research, supported by the AIRC Foundation for research against Cancer, was coordinated by Barbara Alicja Jereczek-Fossa, Principal Investigator, director of the Eo and full professor of the University of Milan (Statale), together with Dr. Giulia Marvaso, oncologist Radiotherapist IEO, researcher of the Statale and first author of the article.
How much the prostate cancer affects and how to rank
Over the past ten years, prostate cancer has become the Most frequent cancer in menrepresenting 19.8 % of all male tumors. Its incidence increases with the progress of age and mainly affects the male population over 50 with a peak incidence around 70 years. In the year 2023, around 41,100 new diagnoses were carried out in Italy and the men who live with a diagnosis of prostate cancer are 564,000. There net survival at 5 years from the diagnosis it is Around 90%. In each patient, specialists carry out a stadial, based on the TNM classification (tumor, node, metastasis). The TNM system is based on the execution of second level diagnostic tests such as magnetic resonance imaging or TC EE the evaluation of some parameters, from the extension of the primary tumor (Category T – The value of this parameter varies from T0, tumor not present, to T4, tumor that has invaded the adjacent structures) the diffusion or not of cancer to the neighboring lymph nodes (category N), the absence or presence of metastases distant (category m).
Another fundamental element in the evaluation of the disease is the histological characterization. The Gleason is the histological score of reference in prostate cancer and represents one of the most important independent prognostic factors. This system takes into account the appearance of cancer cells and their architectural organization and attributes a growing score as the aggressiveness of the neoplasm, with reference to the two most widespread forms in the bioptic sample examined.
What the study demonstrates
The radiant study is a randomized clinical experimentation of phase II, a total of five years, in which they were enrolled and treated 102 patients With oligometastasi from prostate carcinoma, from an average age 70 years, divided into two arms. One arm has been treated with only stereotaxic radiotherapy, while the other has been treated with stereotassics associated with a brief hormonal therapy. The results showed that patients belonging to the second group recorded a period of survival without a progression of 32 months diseasecompared to the 15 months of those of the first group.
“The results of Radiosa represent a significant step forward in the most precise and targeted treatment of oligometastatic prostate cancer, highlighting the importance of combined strategies to improve the clinical results and the quality of life of patients – comments Jereczek. The data collected, if confirmed in wider studies, could contribute to a paradigm change in the management of metastatic neoplasm from prostate carcinoma. This would confirm the possibility of using short and intermittent hormonal therapies, associated with stereotaxic radiotherapy, also in the metastatic disease, where the standard was represented so far by continuous and life therapies “.
How radiotherapy works
Stereotassic radiotherapy, also known as radio control or radioabulation (if performed in a single session), is revolutionizing the therapeutic paths in the management of metastatic disease.
“This treatment non -invasive, outpatient It is compatible with normal daily activities, in fact it represents a turning point for many patients – underlines the expert. For some selected patients, radiosurgery can replace drug therapy, offering a holiday from drugs. In others, with metastatic disease already under pharmacological treatment, it allows you to treat active metastases, keeping control over latent ones thanks to drugs. More and more often, the combination of drugs and radiotherapy is becoming the new treatment strategy, improving the quality of life of patients and opening new opportunities for increasingly effective therapies “.
How to deal with prostate cancer
In general terms, the treatment of prostate cancer has different objectives according to the extension and aggression of the disease, the patient’s life expectancy and the presence of concomitant pathologies that can represent a risk of death higher than that of the same prostate disease. It is based on thesurgeryon the medical therapy and precisely on the radiotherapy. Since the proliferative stimulus at the level of the prostate cancer cell is guided by the activation of the androgen receptor by testosterone, the main therapeutic strategy is represented by the reduction of circulating testosterone levels, through androgenic deprivation.
But be careful: The treatments must be chosen on a case -by -case basis. In patients with localized disease and with low risk of progression there are different therapeutic strategies that can also be adopted on the basis of monitoring the advancement of the disease through periodic checks in order to reduce the side effects of the treatments. In patients with localized disease and with intermediate-high progression risk, on the other hand, an external radiotherapy treatment may be recommended and/or androgenic deprivation therapy as well as the prostatectomy intervention followed by adjuvant hormonotherapy. Later, on a case -by -case basis, the Team of specialists The patient follows in the “prostate unit” can decide the most suitable treatment.
