High-grade prostate cancer: whole-pelvis RT adds benefit to external RT+brachytherapy

  • Sandler KA & al.
  • Eur Urol
  • 13 Apr 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Whole-pelvis radiotherapy (WPRT) improved biochemical recurrence-free survival (bRFS) in patients with high-Gleason-grade prostate cancer who received external beam radiotherapy (EBRT) plus brachytherapy (BT), but not in those treated with EBRT alone.
  • WPRT did not improve distant metastasis-free survival (DMFS) and prostate cancer (PCa)-specific survival (PCSS).

Why this matters

  • Further studies to optimize WPRT are warranted, including with the use of more potent radiosensitizing androgen deprivation therapy agents and/or with advanced imaging to identify occult nodal disease.

Study design

  • Study of 1170 patients with Gleason grade group 5 PCa received EBRT (n=734) or EBRT+BT (n=436) between 2000 and 2013.
  • Funding: None.

Key results

  • 41% of patients in the EBRT group and 73% in EBRT+BT group received WPRT.
  • Median follow-up was 5.6 years.
  • WPRT significantly improved bRFS in patients treated with EBRT+BT (HR, 0.5; P=.02), but not those treated with EBRT (HR, 0.8; P=.4).
  • No significant difference was observed in DMFS or PCSS in patients who received WPRT:
    • EBRT group: HR, 1.1 (P=.8) and 0.7 (P=.1), respectively.
    • EBRT+BT group: HR, 0.6 (P=.2) and 0.5 (P=.1), respectively.

Limitations

  • Retrospective design.

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