OBR OncologyHigh-Dose RT Plus Long-Term ADT Ups Survival in High-Risk Prostate Cancer

Enhanced Outcomes with High-Dose Radiotherapy and Long-Term Androgen Deprivation Therapy in High-Risk Prostate Cancer

Recent findings presented at the 2024 ASCO Genitourinary Cancers Symposium underscore a significant advancement in the treatment of high-risk prostate cancer. Combining long-term androgen deprivation therapy (LT-ADT) with dose-escalated radiotherapy not only enhances survival rates but does so without increasing toxicity. This breakthrough offers a new standard of care for patients with high-risk prostate cancer, marking a pivotal shift in therapeutic strategies.

Key Points:

• Long-term androgen deprivation therapy (LT-ADT) combined with dose-escalated radiotherapy significantly improves progression-free survival (PFS) and overall survival (OS) in patients with high-risk prostate cancer, compared to LT-ADT with conventional-dose radiation therapy.
• The phase 3 GETUG-AFU 18 trial demonstrated that high-dose radiotherapy (80 Gy) yields better outcomes in terms of PFS, cancer-specific survival, and OS than a standard-dose (70 Gy), without an increase in toxicity.
• Eligible patients included those with a prostate-specific antigen of 20 ng/mL or more, a Gleason Score of 8 or higher, or clinical stage T3–T4, indicating high-risk prostate cancer.
• With a median follow-up of 114.2 months, the 10-year PFS rate was 84% for the 80 Gy group versus 72% for the 70 Gy group, showing a significant improvement with the higher dose of radiation therapy.
• Cancer-specific survival at 10 years was also superior in the 80-Gy group, at 96% compared to 90% in the 70-Gy group.
• The 10-year overall survival rate was 77% for patients receiving 80 Gy, significantly higher than the 66% observed in the 70 Gy group.
• No significant differences were found between the two groups regarding late genitourinary toxicity or late digestive disorders, indicating that the higher dose does not add toxicity.
• Quality of life measures did not significantly differ between patients treated with the conventional dose versus the dose-escalated radiotherapy, further supporting the regimen’s safety.
• The study’s results provide level I evidence supporting the combination of high-dose radiotherapy with LT-ADT as a new standard of care for patients with high-risk prostate cancer.

“Even if we use long-term ADT, high-dose of radiotherapy (80 Gy) improves progression-free survival, cancer-specific survival, and overall survival compared to a more standard-dose of 70 Gy in high-risk prostate cancer without increasing toxicity, but, obviously, [intensity-modulated radiation therapy (IMRT)] is required to obtain this result.”
– Christophe Hennequin, MD, PhD, Department of Radiation Oncology at Saint-Louis Hospital in Paris, France

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