STAMPEDE-ing caravan.

Top Line: Radiation for oligometastatic cancer is what’s up, so let’s revisit the prostate question.
The Study: Last month, we talked about HORRAD… Ho rad… Hold rad… hold the rad? HORRAD showed no improvement in overall survival (OS) with prostate-directed radiation among a broad group of men with bone-metastatic prostate cancer. But now that oligometastatic treatment is...what’s the word...invading all our treatment paradigms, where should we turn for clarity? Well STAMPEDE, of course. This version randomized over 2000 men with any extent of metastatic prostate cancer to +/- prostate radiation in the setting of standard of care androgen ablation. An important point here is that the primary endpoint was OS, which was not better with radiation. However, the excitement comes from the 40% of men with “low-burden” disease. As in CHAARTED, low-volume was defined as <4 bone mets and no visceral mets on standard bone scan and CT. These guys did have a significant improvement in OS from 73→ 81% at 3 years. Your friendly urologist who operates on Gleason 9 disease is gonna be super cautious in applying these results, so let’s look at the big picture. Most of the details we debate about treatment of localized prostate cancer have absolutely no improvement in OS, in contrast to what was seen here. Furthermore, we’re not talking about a novel therapy with unknown long-term results. Will we get a randomized trial for men with low-burden disease? Hard to say. But the authors of the study feel pretty strongly that we pull the trigger for appropriately selected men.
Bottom Line: Among men with low-burden metastatic prostate cancer, prostate radiation significantly improves rate of OS at 3 years. | Parker, Lancet 2018


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