There’s mixed data on whether prostate-directed radiation improves survival for men with metastatic prostate cancer, and it appears to mainly benefit those with low volume metastatic disease. PEACE-1 is a large, multi-armed trial investigating treatment intensification for metastatic castration sensitive prostate cancer. You’ll probably recall it showing improved survival with triplet therapy (ADT, abiraterone, and docetaxel) for mCSPC. In this sub-study, 1172 men with low volume metastatic disease (0-3 bone mets with or without nodal involvement) were randomized to standard therapy (ADT +/- docetaxel) with or without 74 Gy in 37 fractions to the prostate. Things get complicated as docetaxel was given with ADT at physician discretion in the standard arm. In addition, there was an interaction between RT and abiraterone for radiographic PFS. Overall, RT did not statistically improve rPFS (3 v 2.6 years) or OS (7.5 v 6.9 years) across groups. However, when compared among specific systemic therapy groups, those who received standard treatment + RT + abiraterone had superior rPFS. | Bossi, ASCO 2023
