If only it were a pill.

Back in 2018, a protocol from the STAMPEDE trial showed that radiation to the prostate for men with low-volume metastatic prostate cancer improved survival at 3 years (81% v 73%). Low volume metastatic disease was defined as <4 bone metastases and no visceral metastases. Over 800 patients (40% of the trial population) had low volume disease. In this update, the survival benefit of radiation for low volume disease persisted long-term with a 5 year OS rate of 65% with RT and 53% without. Median survival was 85.5 v 63.6 months. In those with high volume disease, there was no benefit with prostate RT. The authors also took a look at whether 36 Gy in 6 weekly fractions or 55 Gy in 20 daily fractions performed better, but there was no evidence of an interaction in treatment effect based on the regimen used. Another important takeaway was that RT did not increase the rate of any grade 3+ events (44% v 45%). There was also no detriment to quality of life with RT.  | Parker, PLOS Medicine 2022


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