GU Cancers 2024 | The role of radiation in managing high-risk localized prostate cancer
Sophia Kamran
• 26 Jan 2024
Sophia Kamran, MD, Massachusetts General Hospital, Boston, MA, gives an overview of treatment options for high-risk localized prostate cancer, which typically consists of surgery or radiotherapy and androgen deprivation therapy (ADT). Findings from the GETUG-AFU 18 trial (NCT00967863) of radiotherapy and ADT demonstrated the benefits in overall survival of dose escalation of radiotherapy. However, more research is needed to elucidate quality of life and toxicity in patients. This interview took place at the ASCO GU Cancers Symposium 2024 in San Francisco, CA.
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Transcript (edited for clarity)
So there’s a big role for radiation in the higher risk localized prostate cancer setting and I think it’s evolving. We’re, you know, evolving our techniques, our technology is becoming better. And we’re learning a lot more about high risk prostate cancer...
So there’s a big role for radiation in the higher risk localized prostate cancer setting and I think it’s evolving. We’re, you know, evolving our techniques, our technology is becoming better. And we’re learning a lot more about high risk prostate cancer. And, you know, high risk prostate cancer can be challenging entity to treat. So, you know, if patients come with high risk localized prostate cancer, they have two treatment options. One is surgery and then the other is radiation therapy plus androgen suppression, long term androgen suppression. And then there’s kind of different, you know, caveats to, to what we to how we offer either of these treatments, but again, radiation is evolving.
We saw a very nice presentation yesterday, GETUG-AFU 18, in the high risk localized prostate cancer setting that actually found that dose escalation up to 80 Gray in these in this patient population was was extremely beneficial for clinical endpoints specifically including overall survival, which is probably this is the first time that I think we’re seeing a dose escalation trial in prostate cancer, where we’re actually seeing an overall survival benefit to dose escalation and all the prior dose escalation prostate cancer trials. We’ve only seen benefits in in other really important clinical endpoints like distant metastasis, free survival or prostate cancer specific survival, all those things. But this was the first time we’re seeing it for overall survival.
Now we have to be careful. We always have to think about toxicity and also of course, patient quality of life, so I think we want to see patient reported outcomes. We want to look more specifically at the toxicity between the two arms. One thing that was interesting is that in the dose escalated arm in GETUG-AFU 18, it was found that the majority of patients actually received IMRT, intensity modulated radiation therapy, which is again a more modern technique, more modern technology for radiation. And that may be why, you know, we’re seeing the results that we we found, but it’s just something that we need to think about and, and just be more cautious about. But it is exciting. So there’s a lot of great areas you know, we’re exploring, micro boosting like the FLAME trial. There’s explorations of using brachytherapy boosting. and then of course there’s a lot of, new technology with regards to imaging how we actually diagnose these patients. So PSMA PET in the high risk setting, that’s going to help, you know, personalize treatments for these patients. And then of course, there’s genomic classifiers such as decipher things like that that can also further personalize treatment. So I think it’s very, very exciting for patients that have high risk localized prostate cancer. There’s just going to be more, better and better options for treatment for these patients.
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