Dr. Yu on the Role of Radiation in Prostate Cancer

James B. Yu, MD, MHS, professor of Therapeutic Radiology at Yale School of Medicine, and associate chief medical officer for Radiation Oncology, and medical director Smilow Radiation Oncology, at Smilow Cancer Hospital, discusses the utility of radiation in men with prostate cancer.

Two groups of data support the use of radiation in metastatic prostate cancer, says Yu. The first concerns the efficacy of radiation when a patient already has metastatic disease. The phase 3 STAMPEDE study, which included patients with a low metastatic burden who benefitted from treatment with radiosurgery or radiation therapy, helped to answer this question, according to Yu.

That was a revelation for the field because if the cancer is spreading, the question now has to do with the utility of local treatment when the primary concern is dealing with the metastatic disease, says Yu; theoretically, this might be helpful because it prevents future metastatic disease from the primary tumor. In general, this also decreases disease burden, which will prove beneficial for patients with metastatic disease.

The second batch of evidence pertains to metastatic disease that is recurrent or metastatic disease where the primary tumor has already been treated, adds Yu. Results from multiple studies have demonstrated that if all sites of metastatic disease are treated with focused radiation, the prostate-specific antigen levels can be better controlled, the hormonal therapy could be decreased, or, if a patient is on life-long hormonal therapy, future metastatic disease could potentially be decreased, concludes Yu.