The Finnish FinnProstataX study investigated whether radiotherapy administered after the removal of the prostate benefited patients whose cancer had spread to the surface of the prostate or beyond the capsule that surrounds the prostate. At the moment, treatment practices in these situations vary. The randomized study carried out in 2004-2012 included 250 patients. Of these 250 patients, 126 received adjuvant radiotherapy after the removal of the prostate; while the treatment of 124 patients consisted of the mere removal of the prostate.

Radiotherapy administered

Over the roughly nine-year follow-up, only two patients  one from each group – died of prostate cancer. Based on PSA measurements; 82% of the members of the adjuvant treatment group were disease-free at the end of the follow-up period; the equivalent % in the control group was 61. An increase in the PSA value usually precedes the recurrence of prostate cancer, and in the study; the patients with a maximum PSA of 0.4mg/l were determined to be disease-free.

No metastases were detected in 98%of those in the adjuvant treatment group and 96% of those in the control group during the follow-up period. “Tolerance for the adjuvant treatment was good; and it prolonged the disease-free period measured from the PSA compared to the mere surgical removal of the prostate. Even so; the adjuvant treatment did not extend patients’ survival;” says professor Akseli Hemminki; summing up the results of the study.

Surgical removal of the prostate

Prostate cancer may generate metastases and; in the worst case, result in death more than 10 years after the recurrence of the disease, detected from a PSA increase. Given that the patients in this study were monitored for less than 10 years on average, it’s only natural that the treatment we studied did not have a significant impact on survival. In even longer follow-up; a difference in PSA increases could also lead to a difference in mortality.”

Greetta Hackman (Lic.Med.), article’s lead author Hackman stresses that when making treatment decisions, it is important to discuss the available options openly with the patient. “More treatment also means more side effects. However, at the same time, we can likely influence the disease’s prognosis in a situation in which the cancerous tissue already extends to the prostate’s surface or has penetrated through the prostate’s capsule, but has not yet metastasized.”

Influence the disease’s

The parties involved in the study, published in the respected journal European Urology, were the universities of Helsinki and Tampere and the university hospitals of Helsinki and Tampere; the university hospitals of Oulu, Kuopio and Turku; the central hospitals of Päijät-Häme, Mikkeli and Joensuu; Docrates Cancer Center and the Finnish Cancer Registry. “This study is a great example of cooperation between Finnish hospitals and universities to perform an important research-driven academic clinical trial. There are not many studies of this kind these days,” says Hemminki.