Top Line: Can we increase the intensity of treatment for very high risk prostate cancer while reducing the long term duration?
The Study: As radiation oncologists know all too well, people often underappreciate the cumulative burden of prolonged systemic therapy when treating high risk or advanced cancers. High risk prostate cancer patients in particular can be on antiandrogen therapy for years. This single arm, phase 2 trial took the approach of increasing the intensity of therapy for high risk disease while shortening the duration. The trial included 63 patients with very high risk prostate cancer (Gleason score 8 to 10, prostate-specific antigen (PSA) ≥20, clinical or radiographic ≥T3, or >4 cores containing Gleason score 8 disease). They were treated with SBRT to the prostate and SVs along with 6 months of leuprolide, abiraterone, and apalutamide. At 3 years, the rate of biochemical recurrence was 19%, biochemical recurrence free survival was 84.2%, and metastasis free survival was 93.6%. The authors set a superiority threshold of BCR <10%, which the study did not meet. However, the BCR rate and other outcomes are in the ranges of other historic benchmarks for this high risk population. Most patients had testosterone recovery by 6 months after completing treatment.
TBL: While SBRT and intensified antiandrogen therapy didn’t signal superiority in this small phase 2 trial, it did achieve favorable outcomes with a much shorter 6 months duration of therapy for very high risk prostate cancer. | McBride, Clin Cancer Res 2026
The Study: As radiation oncologists know all too well, people often underappreciate the cumulative burden of prolonged systemic therapy when treating high risk or advanced cancers. High risk prostate cancer patients in particular can be on antiandrogen therapy for years. This single arm, phase 2 trial took the approach of increasing the intensity of therapy for high risk disease while shortening the duration. The trial included 63 patients with very high risk prostate cancer (Gleason score 8 to 10, prostate-specific antigen (PSA) ≥20, clinical or radiographic ≥T3, or >4 cores containing Gleason score 8 disease). They were treated with SBRT to the prostate and SVs along with 6 months of leuprolide, abiraterone, and apalutamide. At 3 years, the rate of biochemical recurrence was 19%, biochemical recurrence free survival was 84.2%, and metastasis free survival was 93.6%. The authors set a superiority threshold of BCR <10%, which the study did not meet. However, the BCR rate and other outcomes are in the ranges of other historic benchmarks for this high risk population. Most patients had testosterone recovery by 6 months after completing treatment.
TBL: While SBRT and intensified antiandrogen therapy didn’t signal superiority in this small phase 2 trial, it did achieve favorable outcomes with a much shorter 6 months duration of therapy for very high risk prostate cancer. | McBride, Clin Cancer Res 2026