According to the results of the STAMPEDE trial.(1) adding radiotherapy (radiation) to the current standard-of-care androgen deprivation therapy (ADT of hormone therapy) did not improve the overall survival in all men who are newly diagnosed metastatic prostate cancer if they have a heavy disease burden (three or more mets).

However, the trial did show that the overall survival was improved in those men with a low metastatic burden at diagnosis (three or fewer mets) who were assigned to have radiotherapy added to their treatment protocol of ADT and chemotherapy. Three-year survival in these men was 81% with radiotherapy compared with 73% in the standard-of-care group. These results are consistent with a previous study that showed that survival might be improved in patients with a low metastatic burden following radiotherapy.(2)

“Evidence suggests that prostate radiotherapy improves overall survival for men with metastatic prostate cancer who have a low metastatic burden, but not for unselected patients,” the researchers wrote. “Prostate radiotherapy should be a standard treatment option for men with newly diagnosed disease with a low metastatic burden.”

When you consider having any treatment, it is a good idea to consider both the treatment benefits as well as the possible treatment side effects. In the case of this trial adding radiotherapy to ADT the, radiation was well tolerated, with 5% of the men reporting adverse events during radiotherapy and 4% reporting events after radiotherapy. The proportion of men reporting at least one serious adverse event was similar between both groups.

References

1. Park CC, James ND, Brawley CD, et al. Radiotherapy to the primary tumour for newly diagnosed metastatic prostate cancer (STAMPEDE): a randomized controlled phase 3 trial[published online October 21, 2018. Lancet Oncol. doi: 10.1016/S0140-6736(18)32486-3

2. Boevé LMS, Hulshof MCCM, Vis AN, et al. 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 [published online Sept 25]. Eur Urol. doi: 10.1016/j.eururo.2018.09.008