Men who have had prostate cancer surgery do not need immediate radiotherapy
17 May 2024
People who have surgery to remove their prostate do not need immediate radiotherapy to prevent their cancer from returning. These results from the RADICALS-RT trial were published in Annals of Oncology today.
Radiotherapy is widely used after surgery for prostate cancer. Previous research had shown that surgery plus radiotherapy for everyone was better at preventing the cancer returning than surgery alone. However, it is not clear which people need radiotherapy and when.
To address these questions, the RADICALS-RT trial compared if a policy of giving radiotherapy soon after surgery to all patients was better than using radiotherapy only if there was early evidence the cancer had returned. The early evidence would be rising PSA, a blood marker that indicates prostate cancer, even if the values were still very low.
The RADICALS-RT trial included 1,396 participants from the UK, Denmark, Canada and Ireland. They were allocated, soon after surgery, into two groups at random:
- One group was planned to have radiotherapy soon after surgery.
- One group was planned to be followed and radiotherapy given only if their prostate cancer returned.
In 2020, researchers from the MRC Clinical Trials Unit at UCL published the first set of results from RADICALS-RT, which found that this group of men who had surgery to remove their prostate did not benefit from immediate radiotherapy.
The team have now followed up these men for around eight years on average. These updated results confirm that there is no clear evidence of a benefit from a policy of giving radiotherapy soon after surgery, when compared to giving radiotherapy only if the cancer returns. The trial also found that radiotherapy soon after surgery resulted in a higher risk of unwanted side-effects, such as urinary and bowel problems.
In the group who were planned to be followed and given radiotherapy only if the cancer returned after surgery, around half avoided the need for radiotherapy.
These results mean that people who have surgery to remove their prostate cancer can often avoid radiotherapy, with its associated costs and side-effects. Instead, they can be regularly monitored, with radiotherapy only used if their cancer shows early signs of coming back.
As these results support that giving radiotherapy only when needed is a better approach for most people, the RADICALS-RT team argue that this should be the standard procedure after surgery.
The RADICALS-RT trial was funded by Cancer Research UK and Medical Research Council, and took place in hospitals throughout the UK, as well as Canada, Denmark and Ireland. The trial was sponsored by UCL.
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