By Arthur A. Burley 
Radical prostatectomy, a surgical procedure to treat prostate cancer, is a common option for many men. They live happily and have no recurrences. However, 20% to 40% will see a rise in prostate-specific antigen levels in the 10 years following surgery. PSA levels should not be detected in blood after removing the prostate. This indicates that cancer may have recurred. This is called a biochemical or biological relapse; doctors usually treat it with radiation to the prostate bed. The prostate was there before the surgery. This treatment, also known as pelvic bed radiation therapy (PBRT), often brings PSA down to zero for many years.
A large study has shown that PBRT works even better when combined with other treatments. These findings could be a game-changer in men who have experienced a biochemical relapse following radical prostatectomy.
The SUPPORT Phase 3 Clinical Trial was funded by the National Cancer Institute. It was carried out at almost 300 medical centers in the United States, Canada and Israel. Between 2008 and 2015, 1,797 men participated in the SUPPORT phase 3 clinical trial. All of them had post-surgical PSA levels between 1 and 2 nanograms/mL (ng/mL).
Randomly, subjects were assigned to one of the three groups. Men in the first group received PBRT alone, while those in the second group received PBRT with ADT, which combined four to six months worth of androgen-deprivation therapy. ADT, also known as hormonal therapy or hormonal therapy, blocks testosterone, a hormone that fuels the growth of prostate tumors. Group 3 men received ADT, PBRT, and radiation to the pelvic lymph nodes. This is where prostate cancer usually spreads first. Researchers wanted to determine which strategy was most effective in preventing disease progression.
Side effects and results, as well as what’s next
Their results showed that intensive treatment led to better outcomes. Over 70% of the men in Group 1 had not developed disease progression by five years. This was compared to 80.3% in Group 2 and 87.4% in Group 3. In particular, 145 men in the 1 group developed additional PSA elevations over the follow-up period compared to 104 men from group 2 and 83 in group 3. Similar trends were observed in the number of men who developed metastases (a form of cancer that is resistant to hormonal therapy) after spreading.
Side effects that were more severe, such as diarrhea, occurred in the intensive treatments. After three months, there was no difference in side effects among the three groups.
However, the authors stressed that more follow-up is needed to determine if adding ADT or pelvic node radiation (PBRT) actually prolongs survival. The study also did not examine a new therapeutic strategy for biochemical relapse. This is where doctors use innovative imaging techniques to locate small metastases in the body and treat them with radiation.