Is Local Radiation Beneficial in Metastatic Prostate Cancer?

Gerald Chodak, MD


December 20, 2018

Hello. I'm Dr Gerald Chodak, for Medscape. Today's topic addresses an important question in the management of men with newly diagnosed metastatic prostate cancer. Namely, is there benefit from treating the local tumor?

To evaluate this, Parker and coworkers[1] have recently reported on the STAMPEDE trial, in which 2000 men with metastatic disease were randomized to receive either androgen deprivation therapy alone or in combination with local radiation therapy.

An important feature was the study design, in which they stratified patients based on low-volume or high-volume metastatic disease, where low-volume disease meant having fewer than four metastatic sites. So far, the overall results have been disappointing in that there was no statistically significant improvement in survival.

However, when they looked at patients with low-volume metastasis, there was a statistically significant improvement [in overall survival]. However, this improvement was rather small, meaning that at 3 years, the overall survival was 73% in the control group compared with 81% in the group receiving radiation. This translates into about 1 out of every 12 men benefiting from therapy. Additionally, mean survival was only improved by 3 months.

On the basis of these findings, the authors have suggested that this regimen should become the standard of care. Although I am not sure that's true given the relatively small improvement in survival, there clearly is a benefit. At the very least, patients should hear about these findings and be offered [the option of local radiation therapy].

This study also has implications for ongoing randomized trials in which surgery is being evaluated in men with metastatic disease. Hopefully, accrual [in these trials] will go well.

Overall, this study is well done, and the morbidity of the added therapy was relatively low. Many men may find that even if the benefit is small, [the additional radiation therapy] is worth taking. I look forward to your comments. Thank you.


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