PSA Trends and Clinical Outcomes Following Radiotherapy Combined with Androgen Deprivation Therapy for Prostate Cancer: A Single-Centre Retrospective Cohort Study from Saudi Arabia

Prostate cancer is a disease that affects the male reproductive system, often developing slowly over many years. For men whose cancer has spread beyond the early stages or shows signs of being more aggressive, doctors typically use a two-pronged approach to fight it. The first part involves radiation therapy, which uses high-energy beams to target and destroy cancer cells in a specific area of the body. The second part involves a treatment called androgen deprivation therapy. This treatment works by lowering the levels of male hormones, known as androgens, in the body. Since prostate cancer cells rely on these hormones to grow, cutting off their supply essentially starves the tumor, making it smaller and more vulnerable to the radiation. While this combination is a standard way to treat the disease, most of the large studies confirming how well it works have come from Western countries. Because people in different parts of the world can have different health profiles and respond to treatments in unique ways, scientists have been eager to see how this approach performs in the Gulf region, where rates of prostate cancer are rising.

A team of researchers at King Abdulaziz Medical City in Riyadh, Saudi Arabia, set out to fill this gap by looking back at the records of 74 men who received this combined treatment. These patients were adults diagnosed with prostate cancer, and the researchers wanted to see exactly how their bodies responded over time. They focused on a specific marker called prostate-specific antigen, or PSA, which is a protein produced by the prostate gland. When the prostate is healthy, PSA levels in the blood are usually low. When cancer is present, these levels often rise. After treatment, doctors watch to see if PSA levels drop, as a deep and lasting drop usually means the cancer is under control. The team tracked these levels at the start of treatment and then again at three, six, and nine months later. They also kept a close eye on how the patients felt, looking for any side effects like trouble with urination or sexual function, and monitored whether the cancer ever came back.

The results showed that the treatment worked very quickly and effectively for the men in this group. By the three-month mark, the median PSA level had already fallen by more than 90 percent. As time went on, the levels continued to drop. By nine months, the median PSA level had decreased by nearly 99.7 percent from where it started. To put this in perspective, if a man started with a PSA level that was high enough to signal a serious problem, his level after nine months was so low it was barely detectable, with the average lowest point reaching just 0.028 nanograms per milliliter. This deep drop happened regardless of how aggressive the cancer appeared to be at the beginning or how old the patient was. The only factor that made a difference was whether the cancer had already spread to other parts of the body at the time of diagnosis; men who had cancer that had spread to their bones or lymph nodes tended to have slightly higher PSA levels throughout the treatment, though their levels still dropped significantly.

Beyond the numbers, the study found that the treatment was well-tolerated and caused very few serious problems for the patients. In the first year after treatment, fewer than seven percent of the men experienced urinary incontinence, which is the inability to control urination. Similarly, fewer than seven percent reported erectile dysfunction, or the inability to achieve or maintain an erection, by the one-year mark. These rates of side effects were notably low compared to what is often seen in other large studies. The cancer also stayed away for most of the group. Only about five percent of the patients saw their cancer return, and for those few who did, it took an average of nearly six years for the disease to come back. The researchers noted that while the treatment was highly effective in this specific group of Saudi men, the study had some limits. It was a smaller group of patients from just one hospital, and the follow-up period was not long enough to see what happens over many decades. Additionally, the imaging tools used to check for cancer spread were the standard ones available at the time, which are less sensitive than newer technologies that can now detect very tiny spots of disease.

Despite these limitations, the findings offer a clear picture of how this standard treatment performs in a real-world setting in Saudi Arabia. The data suggests that combining radiation with hormone therapy produces a rapid and powerful suppression of the cancer, leading to very low levels of the PSA marker and a low rate of the disease returning in the short to medium term. The low number of side effects suggests that patients in this region can undergo this intensive treatment without suffering the heavy burden of complications that sometimes accompany it. While the researchers emphasize that longer studies are needed to confirm that these early successes translate into a longer life for everyone, the results provide strong evidence that this approach is both effective and safe for men with intermediate to high-risk prostate cancer in this part of the world. It adds a valuable piece to the global puzzle of cancer care, showing that a treatment proven elsewhere works just as well in a different population with its own unique health characteristics.