Can We Beat Prostate Cancer Using Less Radiation?

Patients undergoing radiation treatment for prostate cancer can expect to be under the beam for a term of up to nine weeks. A radiation oncology from the University of Pennsylvania thinks that is too long.

Justin Bekelman, MD, an associate professor of Radiation Oncology, Medical Ethics, and Health Policy at the University of Pennsylvania’s Perelman School of Medicine and Abramson Cancer Center believes that just four to five weeks of daily radiation treatments at higher doses – a routine known as moderate hypofractionation – will do the trick.

“Moderate hypofractionation is high-quality, patient-friendly cancer care at lower cost,” Bekelman said. “It is equivalent to longer radiation schedules in curing prostate cancer, has similar side effects, and is more convenient. Men can get back to their lives more quickly, which means less time away from the activities they enjoy and less time distracted by their cancer treatments.”

Bekelman is forming his opinion from data released from three multi-center randomized trials that compared the efficacy of longer and shorter periods of radiation. Overall, 5,537 patients with mostly low and intermediate risk prostate cancer served as trial subjects. Both the standard long-term and the moderate hypofractionated regimens led to similar cancer control as well as similar side effects, as gauged by doctors and as reported by patients themselves. The results were consistent across different ages and races and held up despite the severity of the disease. There was also no change based on whether patients had undergone hormone therapy, a common treatment for prostate cancer which lowers the male hormone and can be combined with daily radiation.

Putting aside matters of overall efficacy and severity of side effects, fewer radiation treatments also means lower costs and less time out of work.

“If we take a clear-eyed look at the evidence, it is unmistakable that many men can get radiation in 4 to 5 weeks, a shorter time frame than in the past,” Bekelman said. “We should move forward to adopt moderate hypofractionation radiation schedules in routine care for appropriate men with prostate cancer.”

Bekelman has been a crusader for less radiation treatment for a while In 2015, he found two-thirds of women treated for early-stage breast cancer in the U.S. receive longer radiation therapy than necessary, despite research that pointed to the need for change years earlier.

The data has been published in the International Journal of Radiation Oncology Biology and Physics.