Three times the wait.

Top Line: We’ve seen three trials (RADICALS-RT, RAVES, and GETUG AFU 17) comparing adjuvant and salvage radiation for prostate cancer. 

The Study: The challenge is that each trial focused on a different primary outcome: freedom from metastasis for RADICALS-RT, biochemical progression for RAVES, and event-free survival for GETUG 17. The ARTISTIC collaboration is a planned series of systematic reviews and meta-analyses of these three trials (and their 2153 patients) that will synthesize outcomes as they are published. In this first series, ARTISTIC analyzes a primary outcome of event-free survival (EFS). Future series will analyze metastasis-free survival, prostate cancer specific survival, and overall survival. They harmonized the definition of EFS among trials as: 1) PSA ≥ 0.4 after radiation, 2) any PSA ≥ 2.0, 3) clinical or radiographic progression, 4) non-trial treatment, or 5) death from prostate cancer. There’s a great table in the manuscript (Table 1) that compares eligibility, treatment, and criteria for early salvage therapy. Over 70% of all patients had at least one of the following: positive margins, extracapsular extension, or pT3a/b disease. At this analysis, 39% of men assigned to early salvage therapy had received radiation. There were 270 events in total and no evidence that an adjuvant RT approach improved the rate of EFS (89% with, 88% without) compared to salvage RT (HR 0.95). These outcomes were also consistent across the three trials analyzed and across pertinent patient sub-groups. 

TBL: The results of three large randomized trials of adjuvant versus early salvage radiation do not demonstrate an improvement in prostate cancer event-free survival at 5 years. | Vale, Lancet 2020


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