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Optimal Therapy for High-Risk Localized Prostate Cancer Remains Unclear
By Will Boggs MD
NEW YORK (Reuters Health) - Among the many approaches and treatment combinations available for men with high-risk localized prostate cancer, the optimal strategy remains to be determined, according to results of a new systematic review.
"Our findings confirm that the approach to high-risk prostate cancer should to be multimodal," Dr. Lorenzo Tosco from University Hospitals Leuven and KU Leuven, in Leuven, Belgium, told Reuters Health by email. "However, the clinical references remain the international guidelines, because not all the therapeutic combinations have a positive effect, with the risk of exposing patients to possible side effects."
High-risk prostate cancer is associated with more than 30% cumulative mortality at 15 years. Treatment options include surgery, androgen-deprivation therapy (ADT), external-beam radiotherapy (EBRT), chemotherapy with docetaxel, next-generation ADT (abiraterone and enzalutamide) and various combinations thereof.
Dr. Tosco and colleagues examined the current evidence regarding the multimodal treatment of high-risk prostate cancer in their systematic review of 77 prospective trials.
Several trials supported the superiority of the combination of ADT and EBRT over EBRT alone with relapse-free and overall survival as outcomes, the team reports in European Urology, online October 2.
Neoadjuvant ADT did not improve outcomes over prostatectomy alone, and there were insufficient data to determine the role of adjuvant ADT after prostatectomy.
Docetaxel improved relapse-free survival in men treated with EBRT plus ADT, but did not improve relapse-free survival after prostatectomy.
Next-generation ADTs have been tested only in early-phase trials so far, leaving their efficacy and safety unclear.
"This is a field in evolution, and our findings should support physicians to pay attention to many studies that could change clinical practice in the near future," Dr. Tosco said.
He added, "The variability in high-risk-prostate-cancer definitions represents an issue to be able to compare scientific results, but hopefully novel biomarkers will permit to define the lethal disease and the responsiveness to various treatments or therapeutic combinations."
"Incorporating biomarker stratification in further trials is crucial to improve care rates through personalized therapy and is currently under investigation in the STAMPEDE trial," write Dr. Valerie Fonteyne and Dr. Piet Ost from Ghent University Hospital, in Ghent, Belgium in a linked editorial.
SOURCE: https://bit.ly/2yycd7m and https://bit.ly/2D6wpki
Eur Urol 2018.
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