Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial

Boevé, Liselotte M.S.; Hulshof, Maarten C.C.M.; Vis, André N.; Zwinderman, Aeilko H.; Twisk, Jos W. R.; Witjes, Wim P.J.; Delaere, K.P.J.; Moorselaar, R. Jeroen A. van; Verhagen, Paul C.M.S.; Andel, George van

doi:10.1016/j.eururo.2018.09.008

Cited by 412 publications

(292 citation statements)

References 27 publications

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“…The survival benefit for local therapy of the prostate in newly diagnosed mPCa is controversial. Recently, Boevé et al reported the results of HORRAD trial. In this prospective study, 432 patients with PSA >20 ng/mL and primary bone mPCa were randomized to either ADT with prostate EBRT (radiotherapy group) or ADT alone (control group) between 2004 and 2014.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, we analyzed CRPC‐related risk factors but not prostate cancer‐specific mortality because of the small number of events. Some retrospective studies suggested that shorter time from initiation of ADT to CRPC was associated with poor prognosis, but it is not certain that the time to development CRPC represents a surrogate predictive for prostate cancer‐specific mortality or overall survival …”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study

et al. 2018

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Background Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial showed the survival benefit for prostate radiotherapy in newly diagnosed prostate cancer patients with a low metastatic burden. The result raises the next question whether additional radiotherapy to metastatic sites could improve the survival in those with a low metastatic burden. Methods We evaluated the efficacy and safety of prostate‐directed radiotherapy (PDRT) with or without metastasis‐directed radiotherapy (MDRT) in newly diagnosed oligometastatic patients who underwent combination of high‐dose‐rate prostate brachytherapy, external beam radiotherapy, and androgen deprivation therapy. Forty patients with bone metastasis and node positive prostate cancer were retrospectively analyzed. Of these, 22 (55%), 3 (7%), and 15 (38%) patients had N1M0, M1a, and M1b, respectively. Eighteen patients (45%) received MDRT to all metastatic sites. All patients initially underwent ≧6 months of androgen deprivation therapy. Oligometastatic disease was defined as presence of five or fewer metastatic lesions. Median follow‐up period was 62.5 months. Results Of the 40 patients, the 5‐year castration‐resistant prostate cancer (CRPC)‐free survival rate and cancer‐specific survival was 64.4% and 87.9%, respectively. Pre‐ or post‐treatment predictive value including prostate‐specific antigen (PSA) at diagnosis ≥20 ng/mL, Gleason grade group 5, positive biopsy core rate ≥51%, PSA nadir level of ≥0.02 ng/mL after the radiotherapy, and no MDRT were significantly associated with progression to CRPC. Patients with MDRT had significantly higher probability of achieving a PSA level of <0.02 ng/mL than those without the therapy (88.8% vs 54.5%, P = 0.0354) and consequently had a better CRPC‐free survival than those without the therapy (HR 0.319, 95%CI: 0.116‐0.877). Comparing PDRT alone, PDRT with MDRT did not significantly increase the incidences of genitourinary and gastrointestinal toxicities. Conclusions This single‐institutional study revealed the feasibility of combining prostate brachytherapy and MDRT for newly diagnosed oligometastatic prostate cancer. This combined approach has potential to prolong CRPC‐free survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study

et al. 2018

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“…The use of EBRT in prostate cancer patients with metastases has historically been limited to treatment with palliative intent. Several studies have proposed that radiotherapy to the prostate would improve the overall survival of patients with metastatic prostate cancer . These data are expected to change the standard of practice, as it is anticipated that patients will be offered the combination of systemic therapy and local radiotherapy, in particular, for patients with low‐volume oligometastatic prostate cancer.…”

Section: Radiotherapy For Metastatic Prostate Cancermentioning

confidence: 99%

Quality of life after external beam radiotherapy for localized prostate cancer: Comparison with other modalities

et al. 2019

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In external beam radiotherapy for localized prostate cancer, acute toxicities are typically transient and mild. These symptoms will disappear within 4–8 weeks after external beam radiotherapy. Some patients might suffer from proctitis with bloody stools as late rectal toxicity. Therefore, it has been shown that external beam radiotherapy has a more pronounced negative impact on bowel function compared with other treatment modalities. However, the recent development of modern beam delivery techniques, including intensity‐modulated radiotherapy, allows us not only to deliver higher doses to the prostate, but also to decrease the doses to the critical organs, resulting in the maintenance of patients’ quality of life within satisfactory levels. Patients’ quality of life after external beam radiotherapy is also strongly related to the total dose, fractionation regimens, dose parameters of the critical organs and treatment plan quality, with a trade‐off between the radicality of external beam radiotherapy and potentially increased toxicity. Radiation oncologists should choose treatment parameters carefully to achieve a reasonable balance between a good oncological outcome and the patient's quality of life.

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“…The median PSA level at the time of randomization was 142 ng/mL and 67% of patients had >5 osseous metastases. With a median follow‐up of 47 months, no difference in OS was detected between the 2 groups (45 months vs 43 months: HR, 0.90 [95% CI, 0.70‐1.14; P = .4]); however, it raised the possibility that this approach could benefit a subgroup of patients with a limited number of bone metastases (HR, 0.68; 95% CI, 0.42‐1.11) …”

Section: Introductionmentioning

confidence: 99%

“…In patients with disseminated mHSPC, the majority of available data have been derived from retrospective analyses, but the results from 2 prospective studies recently were presented …”

Section: Introductionmentioning

confidence: 99%

Metastatic castration‐sensitive prostate cancer: Abiraterone, docetaxel, or…

Barata

Sartor

2019

Cancer

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For decades, the management of patients with advanced prostate cancer has been hormonal therapy, known as androgen deprivation therapy, which is intended to lower testosterone levels. Further incremental progress in the treatment of men with metastatic hormone‐sensitive prostate cancer (mHSPC) has come from the addition of docetaxel or abiraterone acetate to androgen deprivation therapy for more aggressive upfront treatment regimens. Other combinatorial regimens testing the addition of novel therapies currently are in the late stages of development and are expected to further improve the clinical outcomes of these patients. The emergence of new positron emission tomography tracers specifically for prostate cancer, particularly prostate‐specific membrane antigen and fluciclovine, has increased the ability to detect metastatic disease earlier in the course of the disease and has helped to describe a new group of patients with mHSPC and oligometastatic disease. For this group of patients with mHSPC, the authors discuss the existing data with metastasis‐directed therapy and primary tumor‐directed therapy.

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Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial

Cited by 412 publications

References 27 publications

Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study

Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study

Quality of life after external beam radiotherapy for localized prostate cancer: Comparison with other modalities

Metastatic castration‐sensitive prostate cancer: Abiraterone, docetaxel, or…

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