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Long-term outcomes of prostate radiotherapy for newly-diagnosed metastatic prostate cancer

Prostate Cancer and Prostatic Diseases volume 24, pages 1041–1047 (2021)Cite this article

Subjects

Abstract

Background

In patients presenting with metastatic prostate cancer, the role of local therapy is evolving. Two recently reported large-scale randomized trials suggest that radiotherapy (RT) directed at the prostate improves overall survival (OS) in patients with low metastatic burden. We reviewed the experience of prostate RT in this setting at our center.

Methods

The study population consisted of men with newly-diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) referred to a comprehensive cancer center between 2005 and 2015 and treated initially with androgen deprivation therapy. Patients were eligible for inclusion if they received (1) prostate RT with biological effective dose (BED) at least that of a course of 40 Gy in 15 fractions or (2) no prostate RT. The association between receipt of prostate RT and OS was studied. OS was estimated using the Kaplan–Meier method and Cox regression was used to identify factors associated with OS.

Results

The cohort consisted of 410 patients, of whom 128 received prostate RT. Median follow-up 61.0 months. On univariate analysis, receipt of prostate RT was associated with improved OS (HR 0.59, 95% CI 0.45–0.77, p = 0.0001). Median OS in those patients receiving prostate RT was 47.4 months versus 26.3 months in those not receiving prostate RT. In a multivariate Cox model, receipt of prostate RT remained associated with improved OS (HR 0.69, 95% CI 0.50–0.94, p = 0.02). In those treated with prostate RT, increasing BED was also associated with improved OS (HR 0.87 per 10 Gy increase, 95% CI 0.76–0.99, p = 0.03).

Conclusions

This cohort represents the largest single-center experience of primary tumor-directed RT in mHSPC reported to date. In this population, receipt of prostate RT was associated with improved OS and the magnitude of the OS benefit was clinically significant. The possibility of an RT dose-response gradient in this setting merits further study.

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Authors and Affiliations

  1. Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

    Scott C. Morgan, Scott Grimes & Shawn Malone

  2. Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada

    Scott C. Morgan & Shawn Malone

  3. Division of Oncology, Memorial University of Newfoundland, St. John’s, NL, Canada

    Oliver E. Holmes

  4. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    Julia Craig

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  1. Scott C. Morgan
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  3. Julia Craig
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Contributions

Conception and design: SCM, SM, OEH. Administrative support: SG, JC. Provision of study material or patients: SM, SCM. Collection and assembly of data: JC, SG, SCM. Data analysis and interpretation: SCM, SM, OEH. Initial paper writing: SCM. Critical review and final approval of paper: all authors.

Corresponding author

Correspondence to Scott C. Morgan.

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Conflict of interest

The authors declare that they have no competing financial interests in relation to this work. Outside of this work, SCM has served in a consulting or advisory role for Astellas Pharma, Bayer, Janssen, and Tersera. Outside of this work, SM has received honoraria from Astellas Pharma, Bayer, Janssen, and Sanofi, and has received travel and accommodation support from Sanofi and Tersera. The other authors have no financial disclosures.

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Morgan, S.C., Holmes, O.E., Craig, J. et al. Long-term outcomes of prostate radiotherapy for newly-diagnosed metastatic prostate cancer. Prostate Cancer Prostatic Dis 24, 1041–1047 (2021). https://doi.org/10.1038/s41391-021-00339-y

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