Prostate cancer, what is the optimal timing for radiotherapy?

Adjuvant radiotherapy (RT) administered within 4-6 months after surgery has been considered a standard approach based on the evidence that improved local control and prevented metastatic spread based on three previous randomized trials – EORTC 22911, ARO 96-02, SWOG 8794. However, it became apparent from these three trials that 40% of the patients in the surgery alone arm would never require adjuvant irradiation in the next 10 years of follow-up, meaning that there is a substantial number of patients who are overtreated with adjuvant irradiation.

What is the optimal timing for post-surgery RT and which patient may benefit the most from adjuvant or salvage RT are still open questions in oncology, but practice-changing findings from the RADICALS-RT and ARTISTIC trials, together with findings from the STAMPEDE trial, presented at ESMO 2019 this afternoon may reshape how to manage patients with prostate care according to Prof. Fernanda Herrera, CHUV – Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

ESMO Congress 2019 abstracts:

844O – Docetaxel for hormone-naïve prostate cancer: Results from long-term follow-up of metastatic (M1) patients in the STAMPEDE randomised trial (NCT00268476) and sub-group analysis by metastatic burden

LBA49_PR – Timing of radiotherapy (RT) after radical prostatectomy (RP): First results from the RADICALS RT randomised controlled trial (RCT) [NCT00541047]

LBA48_PR – Adjuvant or salvage radiotherapy for the treatment of localised prostate cancer? A prospectively planned aggregate data meta-analysis