%0 Journal Article
%T Potential biological and clinical benefit of prostate-directed interventions in patients with metastatic prostate cancer
%A Kiyohide Fujimoto
%A Makito Miyake
%A Nobumich Tanaka
%A Takuya Owari
%J Archive of "Annals of Translational Medicine".
%D 2019
%R 10.21037/atm.2019.02.30
%X In a recent issue of the Lancet, Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) investigators, Parker et al. (1) reported the updated results of a large prospective randomized control trial (RCT) that attempted to compare the additional radiotherapy with androgen deprivation therapy (ADT) and docetaxel for metastatic prostate cancer (mPCa). In this study, 2,061 men with mPCa were randomly assigned in a 1:1 ratio to receive ADT and docetaxel or ADT and docetaxel with radiotherapy and confirmed that addition of radiotherapy substantially improved failure-free survival [adjusted hazard ratio (HR), 0.76; 95% confidence interval (CI), 0.68¨C0.84; P<0.0001] but not overall survival (HR, 0.92; 95% CI, 0.80¨C1.06; P=0.27) in all patients. Subgroup analysis according to metastatic burden at randomization was prespecified in this RCT. High metastatic burden was defined as ¡Ý4 bone metastases with at least one metastatic lesion outside the vertebral bodies, pelvis, or viscera. All other patients who were evaluable by imaging exams were considered to have low metastatic burden (2). In a subgroup of patients with low metastatic burden, additional radiotherapy had improved overall survival (adjusted HR, 0.68; 95% CI, 0.52¨C0.90), whereas a significant benefit of prostate radiotherapy was not observed in patients with high metastatic burden (adjusted HR, 1.07; 95% CI, 0.90¨C1.28)
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462632/