Patient case: 81-year-old male with Prostate cancer. Genetic variant: PTEN Inactivating. Other conditions: Hypertension, Depression.

Clinical trial: Androgen Suppression Plus Radiation Therapy in Treating Patients With Prostate Cancer

Summary: RATIONALE: Androgens can cause the growth of prostate cancer cells. Drugs, such as leuprolide, goserelin, flutamide, or bicalutamide, may stop the adrenal glands from making androgens. Radiation therapy uses high-energy x-rays to damage tumor cells. Giving these drugs together with radiation therapy may kill more tumor cells.
  PURPOSE: This phase II trial is studying how well androgen suppression with either leuprolide or goserelin and either flutamide or bicalutamide together with radiation therapy works in treating patients with prostate cancer.

Detailed description: OBJECTIVES:
  -  Determine the feasibility of androgen-suppression therapy combined with external-beam radiotherapy and boost brachytherapy (EBRT+BT) in patients with intermediate-risk localized prostate cancer.
  -  Determine the safety of EBRT+BT in these patients.
  -  Determine, in a preliminary manner, the efficacy of EBRT+BT in terms of rate of local recurrence at 5 years, time to prostate-specific antigen failure, and time to first rectal/bladder injury, in these patients.
  OUTLINE: Patients receive either leuprolide intramuscularly or goserelin subcutaneously once every 12 weeks for a total of 24 weeks. Patients also receive either oral flutamide three times daily or oral bicalutamide once daily for 4 weeks.
  Within 4 weeks after initiation of androgen-suppression therapy, patients undergo external-beam radiotherapy (EBRT) once daily, 5 days a week, for 5 weeks. At 2-4 weeks after completion of EBRT, patients undergo transrectal ultrasound-guided boost brachytherapy with implanted iodine I 125 or palladium Pd 103 seeds.
  Patients are followed every 3 months for 2 years and then every 6 months for 4 years.
  PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed adenocarcinoma of the prostate
  -  Must have one of the following prognostic factors:
  -  Stage T1-2, N0; prostate-specific antigen (PSA) ≤ 10 ng/mL; and Gleason score > 6
  -  Stage T1-2, N0; PSA > 10 ng/mL and < 20 ng/mL; and Gleason score ≤ 6
  -  Stage T3a, N0; PSA ≤ 10 ng/mL; and Gleason score ≤ 6
  -  Prostate volume < 60 cc by transrectal ultrasound
  -  No distant or nodal metastases
  -  No metastatic disease by bone scan, CT scan, or MRI
  PATIENT CHARACTERISTICS:
  Age:
  -  18 and over
  Performance status:
  -  ECOG 0-2
  Life expectancy:
  -  Not specified
  Hematopoietic:
  -  Absolute neutrophil count ≥ 1,500/mm^3
  -  Platelet count ≥ 100,000/mm^3
  Hepatic:
  -  Bilirubin ≤ 1.5 times upper limit of normal
  Renal:
  -  Not specified
  Other:
  -  Fertile patients must use effective contraception
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  No prior immunotherapy for prostate cancer
  Chemotherapy:
  -  No prior chemotherapy for prostate cancer
  Endocrine therapy:
  -  Prior androgen-suppression therapy for up to 4 weeks duration allowed if initiated within 4 weeks of study radiotherapy
  -  No other prior hormonal therapy
  Radiotherapy:
  -  No prior radiotherapy for prostate cancer
  Surgery:
  -  No prior surgery for prostate cancer
  -  No prior transurethral resection of the prostate
  Other:
  -  No prior alternative therapy (e.g., PC-SPES) for prostate cancer

Relevance to patient case: not relevant