Re: Radiation Dose Escalation or Longer Androgen Suppression to Prevent Distant Progression in Men with Locally Advanced Prostate Cancer: 10-Year Data from the TROG 03.04 RADAR Trial.
S. Taneja
Jul 27, 2020
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Journal of Urology
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Key Takeaway Key Takeaway: Longer androgen deprivation therapy (ADT) for 18 months reduced distant progression in men with locally advanced prostate cancer, potentially benefiting patients more than radiation dose escalation.
Abstract
available at https://pubmed.ncbi.nlm.nih.gov/32092343 PROSTATE CANCER 879 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Editorial Comment: The delivery of radiation therapy for localized prostate cancer has been explored in many ways with regard to dose, fraction, method of delivery and concomitant duration of androgen deprivation therapy (ADT). When my patients present for radiation consultation, they are offered a multitude of options that are deemed to be of relative equivalence. If they seek a second opinion, they are offered a multitude more. The relative superiority or safety of one method as compared to another is difficult to determine. In this updated report of the RADAR trial men with prostate cancer were randomized to 6 or 18 months of androgen deprivation, followed by assignment to a radiation dose escalation stratile of 66, 70 or 74 Gy external beam radiotherapy (EBRT) or 46 Gy EBRT plus a high dose rate brachytherapy boost (HDRB), largely determined by the preference of the enrolling site. While the article suggests that the study was intended for men with locally advanced disease, the inclusion is quite broad, with any cT2b-4 and cT2a with either prostate specific antigen 10 ng/ml or higher, or Gleason score 7 or higher. Men in this report were followed for a median of 10.5 years. Many cancer related outcomes were evaluated but the primary end point was distant progression. Limitations in the comparative nature of the study include the broad inclusion criteria and a disparate distribution of high risk patients in each radiation dose stratile, with the most high risk patients receiving HDRB or 74 Gy. Several outcomes of the study are noteworthy. Androgen deprivation for 18 vs 6 months reduced distant progression independent of radiation dose or method. A clear improvement in outcomes relative to radiation dose escalation independent of ADT duration could not be demonstrated. The addition of HDRB improved distant progress, cancer specific survival and overall survival compared to 70 Gy EBRT but not consistently against 74 Gy. Use of 18 months of ADT clearly improved distant progression rates in men receiving HDRB. Collectively while multiple comparisons confuse the message of the article to some extent, it appears clear that among these men who have predominantly high risk prostate cancer extended durations of ADT are preferable, and the addition of HDRB may improve outcomes, although not as a replacement for ADT. The latter point is important since many patients are told that combination therapy with HDRB/EBRT obviates the need for ADT, which apparently is not the case. Samir S. Taneja, MD Suggested Reading Amini A, Jones B, Jackson MW et al: Survival outcomes of dose-escalated external beam radiotherapy versus combined brachytherapy for intermediate and high risk prostate cancer using the National Cancer Data Base. J Urol 2016; 195: 1453. Stock RG, Yalamanchi S, Hall SJ et al: Impact of hormonal therapy on intermediate risk prostate cancer treated with combination brachytherapy and external beam irradiation. J Urol 2010; 183: 546. Stone NN and Stock RG: 15-Year cause specific and all-cause survival following brachytherapy for prostate cancer: negative impact of long-term hormonal therapy. J Urol 2014; 192: 754. Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Family History of Cancer and Risk of Paediatric and Young Adult’s Testicular Cancer: A Norwegian Cohort Study R. Del Risco Kollerud, E. Ruud, H. S. Haugnes, L. A. Cannon-Albright, M. Thoresen, P. Nafstad, L. Vlatkovic, K. G. Blaasaas, Ø. Næss and B. Claussen Institute of Health and Society, and Institute of Clinical Medicine, University of Oslo, Department of Pediatric Medicine and Department of Pathology, Oslo University Hospital and Finance Norway, Oslo, National Centre for Occupational Rehabilitation in Norway, Rauland and Department of Oncology, University Hospital of North Norway, Institute of Clinical Medicine, UITeThe Arctic University and Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Tromsø, Norway, and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Br J Cancer 2019; 120: 1007e1014. doi: 10.1038/s41416-019-0445-2 Abstract available at https://pubmed.ncbi.nlm.nih.gov/30967648 880 TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPYavailable at https://pubmed.ncbi.nlm.nih.gov/30967648 880 TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.