Lessons Learned from High Impact Randomized Trials

Mira Keyes, MD, FRCPC, FABS

Mira Keyes, MD, FRCPC, FABS, presented “Lessons Learned from High Impact Randomized Trials” during the 35th International Prostate Cancer Update conference on February 9, 2025, in Vail, Colorado.

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How to cite: Keyes, Mira. “Lessons Learned from High Impact Randomized Trials.” February 9, 2025. Accessed Nov 2025. https://grandroundsinurology.com/lessons-learned-from-high-impact-randomized-trials/

Lessons Learned from High Impact Randomized Trials – Summary

Mira Keyes, MD, FRCPC, FABS, British Columbia Cancer Agency, Vancouver, British Columbia, Canada, outlines advancements in radiation therapy for prostate cancer. In this 17-minute presentation, Dr. Keyes focuses on dose escalation, salvage radiation, and brachytherapy.

Dr. Keyes explains that increasing radiation doses improves biochemical-free survival but raises toxicity risks. Technological advancements such as VMAT, image guidance, and rectal spacers address this. Dr. Keyes cites the FLAME trial, which demonstrated improved biochemical control by boosting MRI-visible lesions with a higher dose, and the HYPO-FLAME trial, which further explores extreme hypofractionation using SBRT.

Dr. Keyes references the ASCENDE-RT trial, which revealed that combining brachytherapy with external beam radiation dramatically lowers recurrence rates. She also shares results from the PACE B trial, demonstrating that SBRT in five sessions offers comparable outcomes to conventional radiation with acceptable toxicity. Dr. Keys asserts that while proton therapy may reduce secondary malignancies, its cost remains a consideration. She also shares that early intervention at lower PSA levels in salvage radiation improves outcomes.

This comprehensive overview emphasizes tailoring treatment strategies to optimize outcomes in prostate cancer management.

About the 35th International Prostate Cancer Update:

The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 35 will feature lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.

The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts. You can learn more about the conference here.

ABOUT THE AUTHOR

Mira Keyes, MD, FRCPC, FABS

Mira Keyes, MD, FRCPC, FABS, is a Clinical Professor of Radiation Oncology in the Division of Surgery at the University of British Columbia in Vancouver, Canada. Dr. Keyes' research interests include prostate brachytherapy, genitourinary oncology, and breast cancer.

About The Author

Mira Keyes, MD, FRCPC, FABS

Mira Keyes, MD, FRCPC, FABS, is a Clinical Professor of Radiation Oncology in the Division of Surgery at the University of British Columbia in Vancouver, Canada. Dr. Keyes' research interests include prostate brachytherapy, genitourinary oncology, and breast cancer. Dr. Keyes earned her medical degree from the University of Novi Sad in Yugoslavia (now Serbia). She completed her fellowship in Radiation Oncology at the Royal College of Physicians and Surgeons of Canada in Vancouver. Dr. Keyes is a Fellow of the Royal College of Physicians and the American Brachytherapy Society. Dr. Keyes has authored and co-authored over 120 publications, has been an invited speaker at many national and international conferences, and has received several grants, including a Canadian Institutes of Health Research (CIHR) and Michael Smith Foundation grant for translational research in prostate cancer. She is a founder of the British Columbia Cancer Agency Provincial Prostate Brachytherapy Program and Vice Chair of the group developing Brachytherapy Diploma Certification with the Royal College of Physicians and Surgeons of Canada, for the purpose of credentialing the brachytherapy training process at a national level. Dr. Keyes is a member of the editorial board of Brachytherapy Journal, the Canadian Association for Radiation Oncology, the Canadian Brachytherapy Group, the American Society for Radiation Oncology, and the European Society for Radiotherapy and Oncology.

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