Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Local Failure and Survival After Radiotherapy for Aggressive Prostate Cancer

Key clinical point: Local failure is an independent predictor of overall survival, prostate cancer-specific survival, and distant metastasis-free survival in advanced localized prostate cancer and a subset of distant metastasis events that are anteceded by local failure events.

Major finding: Patients who had not transitioned to the local failure state had a significantly lower risk of prostate cancer mortality than those who transitioned to the local failure state after radiotherapy.

Study details: An individual patient data meta-analysis of 992 patients enrolled in 6 randomized clinical trials was performed.

Disclosures: None reported.

Citation:

Kishan AU, et al. Eur Urol. 2019 Nov 10. doi: 10.1016/j.eururo.2019.10.008. [Epub ahead of print]

Commentary:

Accurate prognosis in prostate cancer is critical to the selection of appropriate, and potentially curative, treatments. Several potential prognostic factors and scoring systems have been evaluated; however, the effect of local failure on prognosis, while seemingly intuitive, has been unclear. Kishan et al. conducted a meta-analysis of six randomized trials to determine whether local failure was associated with poorer outcomes. In this evaluation of 992 patients, the presence of local failure was associated with worse overall survival, prostate cancer-specific survival, and distant metastasis-free survival. This finding suggests that intensification of local treatments for prostate cancer may be beneficial in select patients.—Mark A. Klein, MD