Hormone therapy can delay prostate cancer spread in people who had surgery and radiotherapy

17 May 2024

People with prostate cancer who have had surgery to remove their prostate and who then receive radiotherapy can benefit from also having two years of hormone therapy. These results from the RADICALS-HD trial were recently published in The Lancet.

Each year, around 7,000 people with localised prostate cancer have surgery to remove their prostate. Around 2,000 of these go on to have radiotherapy after the surgery. However, it has been unclear if they should also receive hormone therapy, a treatment used for more advanced cancers. Researchers already knew that using hormone therapy with radiotherapy was beneficial for people who had not had surgery first.

The RADICALS-HD clinical trial tested whether giving hormone therapy alongside radiotherapy would benefit people who had already had surgery. They randomised patients receiving radiotherapy after surgery to three different groups: one which received no hormone therapy, one which received six months of hormone therapy, and one which received two years of hormone therapy. Doctors and participants could choose to be randomised between all three groups or just two of them. Both two-way comparisons proved more popular for trial recruitment.

The results from RADICALS-HD were presented in two overlapping comparisons: one comparing no hormone therapy to six months of hormone therapy, the other comparing six months of hormone therapy to two years. The people joining the two two-way comparisons were a little different; on average, those in the no hormone therapy versus six months comparison had a more favourable prognosis than those in the six months versus two years comparison.

People taking part in the trial joined between 2007 and 2024 and were followed-up for around 10 years on average. 

RADICALS-HD showed that having two years of hormone therapy delayed the spread of the cancer when compared to having just six months. After 10 years, the proportion of people alive without cancer spreading outside the prostate was 78% in the two years group, compared to 72% in the six months group. This had not (or potentially has not yet) translated into increased survival. 

By contrast, the study found no benefit from adding six months of hormone therapy to radiotherapy, compared with radiotherapy alone, either in terms of cancer spread or survival.

So, in some patient groups, two years of hormone therapy reduces the risk of the cancer spreading. But hormone therapy is associated with important side effects that can negatively affect patients’ quality of life. 

Professor Matt Sydes (MRC Clinical Trials Unit at UCL) said: “These results will help doctors and patients discuss treatment options and take informed decisions about whether having two years of hormone therapy is the right choice for them.

“For patients at higher risk of cancer spread, our study suggests two years of hormone therapy may be a better strategy than six months, although treatment decisions should be based on discussions between doctor and patient.”

The RADICALS-HD 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. 

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