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Topics:
Radiation Oncology • Palliation • Genitourinary Cancers • Prostate Cancer • Medical Oncology
Do you recommend prostate RT for patients with metastatic (M1) disease?
A recent NCBD analysis (Rusthoven et al., PMID 27325855) suggests that the addition of prostate RT significantly improves survival compared to ADT alone in men with M1 disease (propensity score-matched 5-year OS 49% vs 33%, P<0.001). The benefit was limited to men who received ≥65 Gy. Are these data sufficient to consider prostate RT for M1 patients, or is local therapy only indicated to palliate symptomatic disease until the STAMPEDE M1 cohort, as well as other randomized trials, establish a benefit in this setting? If you offer prostate RT to M1 patients, what dose and fractionation do you use?
Answer from: Radiation Oncologist at Academic Institution
I’m excited and honored to see a discussion of this manuscript making it all the way to theMednet!
As Dr. @Howard M. Sandler points out, although the NCDB is an outstanding prospectively-maintained resource, it cannot replace prospective clinical trial data. This is not to say that the trends...
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Radiation Oncologist at Karmanos Cancer Institute - McLaren Proton Therapy Center
I think the answer needs to consider, what is the ...
I think the answer needs to consider, what is the ...
Answer from: Radiation Oncologist at Academic Institution
The JCO paper is interesting but hypothesis generating and so we need to await the results of STAMPEDE before offering RT to men with M1 PC off study with the exception of cases where it is being offered for local control to reduce the risk of obstructive sx's later in a patient with large volume lo...
Answer from: Medical Oncologist at Community Practice
I am a clinician focused on prostate cancer since 1983 -- the so-called "dark ages". I may be the oldest HemOnc MD that continues in practice after all these years. Been there and done that for many aspects of this disease. What is missing in the discussion is a much more intense focus on the stagin...
Answer from: Radiation Oncologist at Academic Institution
The original question referenced STAMPEDE. The results have now been published and showed an OS benefit in a subgroup analysis for patients with "low" metastatic burden (the full trial showed a FFS benefit, but not OS). I offer prostate RT to patients with oligometastatic disease, with this analysis...
Answer from: Radiation Oncologist at Academic Institution
I have heard some arguments for definitive local treatment (prostatectomy or RT) for patients with oligomets, but I do not agree with this approach since there is no high-quality evidence to justify this approach. I only irradiate bulky primary prostate tumor with obstruction (failure in ADT) or for...
Answer from: Radiation Oncologist at Community Practice
An intriguing consensus paper recently published showing a majority recommending primary site therapy for synchronous oligometastatic prostate cancer (https://www.ncbi.nlm.nih.gov/pubmed/28655541). Based on the above comments and this paper, I am currently leaning towards recommending radiation to t...
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Radiation Oncologist at Jacob E Locke MD PA
For non-synchronous pelvic nodal recurrence the an...
For non-synchronous pelvic nodal recurrence the an...
Answer from: Medical Oncologist at Community Practice
If the Radiation establishment believes in the Abscopal Effect, then now is the time to conduct studies of Radiation as an ablative procedure to be joined with immune therapy to increase the effectiveness of the Abscopal effect. M1 is a good indication and will save money and human suffering for the...
Also, the recent HORRAD trial is the only RCT pres...
I think STAMPEDE supports the use of XRT to the pr...
When treating men with low volume disease per STAM...
So great seeing this thread from 2016, where we sa...
Dr. @Spratt - how do you address positive regional...