Delayed Radiation Therapy for Prostate Cancer Did Not Impact Overall Survival

A study found that delaying radiation therapy while remaining on hormone therapy for patients with unfavorable intermediate-risk or high-risk localized prostate cancer to avoid potential exposure to COVID-19 did not negatively impact overall survival.

Delaying radiation therapy while remaining on hormone therapy until coronavirus disease 2019 (COVID-19) cases subside was unlikely to impact survival for patients with unfavorable intermediate-risk or high-risk localized prostate cancer, according to a study published in JAMA Oncology.

Adhering to the COVID-19 stay at home orders is not always an option for patients with cancer receiving radiation treatment, while daily hospital visits only increases the likelihood of exposure for patients. The option to delay treatment until COVID-19 cases flatten minimizes the chance of exposure to the vulnerable population of patients.

"Using a large database of patients with prostate cancer, we validated that the timing of starting radiation could be flexible," Vinayak Muralidhar, MD, a resident in the Department of Radiation Oncology at the Brigham, said in a press release. "Our data suggest that patients can wait for COVID-19 cases to go down before starting radiation. Or, if there's a chance a surge is coming, they could consider undergoing radiation a little earlier than planned and complete it before the surge arrives."

The patients were separated into 4 groups based on when radiation therapy was started relative to hormone therapy and the data found that there was no difference in overall survival among the 4 groups for patients with unfavorable intermediate-risk or high-risk localized prostate cancer.

The study analyzed a cohort of over 63,000 cases of localized prostate cancer found in the National Cancer Database. With this dataset, the researchers from the Brigham and Women's Hospital understood that there could be unmeasured differences patients that were not accounted for but explain the findings.

"Our hope is that our study helps patients and providers make decisions about the timing of treatment," Edward Christopher Dee, a fourth-year student at Harvard Medical School and first author of the study, said in a press release. "These decisions may allow patients to decrease their risk of exposure to COVID-19. Our findings may also provide reassurance to patients and providers who choose to delay treatment."

Researchers developed this study to validate the findings of 2 previous trials that examined the sequence of radiation and hormone therapies timed so that patients receive radiation therapy 2 months after hormone treatment.

These smaller trials determined that the smaller window of timing for radiation and hormone therapy did not impact the outcome.

"The findings are reassuring to patients and allow us to come up with a flexible radiation schedule for prostate cancer that ensures their safety," said Muralidhar. "The results have important implications for patients in areas experiencing a surge in COVID-19 cases who can opt to wait for a safer time to come in and initiate treatment. In the future, we can also look at other types of cancers and treatments and see how delaying therapy has an impact on survival."


Delaying prostate cancer radiation therapy offers room for flexibility in pandemic peak [news release]. Published August 13, 2020. Accessed September 28, 2020.