The European Society for Medical Oncology (ESMO) has issued an e-update on its treatment guidelines for prostate cancer.
Based on the findings of the STAMPEDE and HORRAD trials, prostate radiotherapy (RT) is now recommended in addition to standard systemic treatment as an option for newly diagnosed low-burden metastatic prostate cancer.
The phase 3 STAMPEDE trial, involving over 2,000 patients, showed that prostate RT did not improve overall survival (OS) for un-selected patients. However, RT did improve OS (from 73% to 81% at three years) in those with low metastatic burden (defined according to the CHAARTED criteria). The findings of the HORRAD trial, which included 432 patients, were consistent with STAMPEDE, showing no OS benefit in un-selected patients. Meta-analysis of these two trials found that prostate RT improved three-year OS by 7 per cent for men with less than five metastases on bone scan.
There is also an updated recommendation that combination abiraterone acetate plus prednisone or prednisolone and radium-223 should not be given to patients with metastatic castration-resistant prostate cancer. The update is based on the findings of the ERA 223 trial, which showed that the combination did not improve symptomatic skeletal-related event-free survival but was linked to more fractures.