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Salvage metastasis-directed therapy versus elective nodal radiotherapy
Since recently there were some discussions in regard of preferred approach for BCR (doing the whole area vs treating just active mets) I decided to post these preliminary findings.
This particular study compared 2 methods - the standard one with treating the whole pelvic floor and all nodes with extra boost to positive nodes, and the second method was treating just "glowing nodes". Both involved 6 mos of ADT.
After 4 years metastasis directed method had 63% distant met. free survival rate and the whole area plus nodes group had 76% mets. free survival.
There is phase 3 going on as we speak and it is just to confirm those findings.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00197-4/abstract
One more interesting fact is that both groups had just 6 mos of singleton ADT treatment !!! Something to think about .
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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13% difference is significant enough to base a decision on.
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Hug
3 ReactionsI only read the summary w/o access to the full text. It may be useful to underscore that this does not relate to gland only disease and general 'prophylactic' pelvic nodal radiation without pelvic node disease AND initial negative PSMA PET CT scans AND have not had radical treatment. It is my understanding that prophylactic nodal radiation shows only a BCR benefit for those with an initial PSA >40.
Yes @thmssllvn - this study was done for BCR after RP since you can not radiate the same area twice , it definitely can not be applied to BCR after initial RT.
You concluded correctly - this study was done on patients with visible positive nodes on PSMA scan.
Different studies showed big advantage for RT of the whole pelvic floor + nodes + ADT for BCR without visible PSMA recurrence and uPSA equal or less than uPSA of 0.25 .
This one of them:
"The SPPORT trial (also known as NRG/RTOG 0534) is a landmark phase 3 study that established a new standard of care for men whose prostate cancer returns after surgery. It proved that combining short-term hormone therapy and pelvic lymph node radiation with prostate bed radiation significantly extends the time before the cancer progresses. "
The other one is POP-RT Trial (2020) etc. There are couple more ...
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Hug
3 ReactionsI guess I was trying to emphasize avoiding conflating organ confined disease and surgically removed prostate with metastasis. Inn the former prophylactic (50%) pelvic lymph node radiation appears to have only an effect on BCR with a PSA >40. An overworked RO suggested its use had more benefit than BCR in a <10 PSA.
@thmssllvn
PSA is just one of many parameters. Very aggressive PC actually often produces less PSA than indolent. We were told that by our urologist. My husband had cribriform, IDC and gleson 9 and his PSA was about 5.4 before surgery. I personally would not use PSA as the only parameter for making any decision regarding PC treatment.
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Hug
1 Reaction@surftohealth88 Good comment, I would only add that BCR was the only benefit for 'prophylactic' (50% dose/strength) pelvic lymph node radiation....
in the absence of metastasis. My comments would not apply to the your husband's case after surgery. The study dealt with oligometastatic pelvic disease. This means 5 or less than 5...but 1 is 20% and 5 is five times, i.e., 100%. I do not have access to the full article to determine what the one pelvic lesion SBRT versus the general pelvic 'therapeutic' [?] radiation dose. From the summary available only the term oligo... is characterized which is equal to as little as one or as many as five lesions. 13% improvement for 3,4 or 5 may evaporate for 1 or 2 lesions or be within a margin of error. Another chapter in the Annals of Lumpers and Splitters. There is a big difference in prophylactic (50% dose) use in PSMA PET SCAN non metastatic disease and documented pelvic metastasis. The avoidance of inappropriate conflation in dissimilar clinical presentations was my intention. The dissection of the hyperlinked study is merely a gratuitous foray by an interested side liner.