Dr. Ward on Adding Systemic Therapy to Radiation Therapy in Prostate Cancer

Matthew C. Ward, MD, radiation oncologist, Levine Cancer Institute, Atrium Health, discusses when to consider adding systemic therapy to radiation therapy in prostate cancer.

Patients with a high disease burden require more than radiation therapy alone, says Ward. Typically, patients with a higher burden of disease respond well to radiosensitizers, such as chemotherapy, Ward explains.

The same is true for patients in the adjuvant and salvage settings, Ward says. Patients with high disease burden are more likely to benefit from the addition of hormone therapy to radiation therapy than radiation therapy alone.

For example, findings from the phase 3 RTOG 9601 study (NCT00002874) demonstrated significantly higher rates of long-term overall survival and lower incidences of metastatic disease with the addition of antiandrogen therapy with daily bicalutamide to salvage radiation therapy vs radiation therapy plus placebo in men with recurrent prostate cancer. Additionally, the phase 3 GETUG-AFU 16 study (NCT00423475) reported higher rates of progression-free survival with short-term androgen deprivation therapy (ADT) plus salvage radiation therapy vs radiation therapy alone in men with prostate cancer after radical prostatectomy.

More recent data suggest that patients with higher prostate-specific antigen (PSA) levels may derive more benefit from ADT compared with patients with low PSA levels, who may just derive biochemical benefit, Ward explains. As such, the addition of ADT to radiation therapy should be considered in patients with high PSA levels who are eligible for salvage radiation therapy, concludes Ward.