Men who have had prostate cancer surgery do not need immediate radiotherapy

29 Sep 2020

Men who have had surgery to remove their prostate do not need immediate radiotherapy, according to the results of the RADICALS-RT trial and ARTISTIC meta-analysis. These results were published yesterday in The Lancet journal.

These results are good news for the 7,000 men who are treated for prostate cancer by radical prostatectomy each year. It means most of them can avoid 20 or more trips to the hospital for radiotherapy, and the associated costs and side-effects of that. Instead, they can be regularly monitored, with radiotherapy only needed if their cancer shows signs of coming back.

Previous research had shown that immediate radiotherapy reduced the risk of cancer coming back. However, more sensitive blood tests are now able to pick up the return of cancer earlier, allowing radiotherapy to be given sooner when it is needed. Until now, it was unclear whether immediate radiotherapy still offers patients better outcomes than observation with these improved tests.

The RADICALS-RT trial looked at 1396 men with prostate cancer after they had surgery to remove the cancer. They were randomly split into two groups:

  • One group had radiotherapy immediately after surgery,
  • One group were observed, and only given radiotherapy if their prostate cancer returned

The ARTISTIC meta-analysis looked at the results from three trials looking at this question, to see what the evidence overall says.

Both RADICALS-RT and ARTISTIC found no evidence that immediate radiotherapy delayed the cancer coming back, compared to observation with radiotherapy given when needed. Only one in three men in the observation group in RADICALS had needed radiotherapy within five years. This suggests that two thirds of men can safely avoid radiotherapy, potentially for many years, if they are closely monitored.

RADICALS-RT is continuing to follow-up men in the trial, to see if there is any effect on how long men live.

The RADICALS-RT trial was funded by the MRC and Cancer Research UK and took place in hospitals throughout the UK, as well as Canada, Denmark and Ireland. The ARTISTIC meta-analysis was funded by the MRC.


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