An international medical study, in which a number of Maltese took part, found that patients with prostate cancer benefit highly from radiotherapy when it is combined with hormone treatment.
The study, published in The Lancet, found that men with early prostate cancer, who ran the risk of the disease spreading, responded well to medication that suppressed the levels of the male hormone androgen.
Carmel Cutajar, who led the local study on behalf of the Department of Urology then at St Luke’s Hospital, said there were very minimal side effects.
Prof. Cutajar was the director of surgery at St Luke’s before retiring from public practice in 2001, He explained that treatment in 1987, when the study kicked off, was mainly through radiotherapy or occasionally radical removal of the prostate.
“We wanted to find out what happens if we give patients hormone therapy apart from radiotherapy without surgically removing the prostate,” the urologist said. The study, which started in 1987, under the aegis of the European Organisation For Research in Cancer (EORTC), looked at 415 patients from 17 centres in nine countries. Malta’s Urology Department, which was at the time housed at St Luke’s Hospital, submitted 32 patients, the youngest being 55.
“We have conclusively shown that giving hormones on a long-term basis made a very significant difference in survival after 10 years. Whereas only 30 per cent of patients who received radiotherapy alone survived for 10 years, more than 50 per cent of men who also received hormone therapy survived for a decade,” he said, adding that those who did not survive often did not die because of the disease but of some other concomitant condition or of old age.
Initially patients were given a monthly injection of the hormone suppressor but this was then changed to once every three months.
“This therapy often controlled the disease in many of these patients preventing it from spreading, or even cured them,” Prof. Cutajar said. In fact this treatment regime has been widely accepted in Europe in centres which use radiotherapy for treatment of prostate cancer, he added.
The researchers also wanted to find out whether giving androgen-suppressing hormones on a long-term basis would lead to heart failure or bone fractures. He said that the side effects were found to be minimal.
Asked whether a national prostate screening programme should be introduced, Prof. Cutajar said that this was still a controversial topic and that he would not recommend it for the time being. He explained that whereas it was imperative to remove a malignant nodule in a woman’s breast as early as possible or else it would likely kill her, many men have evidence of malignant changes in their prostate which never progress to cause symptoms.
“In autopsies we have found that a large number of men have evidence of malignant change in their prostate but this was not the cause of death,” he said, adding that national screening would lead to a lot of unnecessary interventions and generate a lot of unnecessary anxiety in patients.
However, he still believes that men over 50 who request to be investigated or who have urinary symptoms should get screened, especially those who have a family history of prostate cancer.
“At the moment it is not clear whether national screening using clinical and laboratory tests would be useful,” he said. However, there are ongoing trials to decide this issue.
Referring to recent research into a new prostate cancer drug by Maltese-born doctor Johann Debono, Prof. Cutajar said despite the obvious limitations, Maltese scientists could still give valid contributions in medical research.