Local Therapy – Managing Locoregional (LR) Complications in Metastatic Prostate Cancer

A. Edward Yen, MD, presented “Local Therapy – Managing Locoregional (LR) Complications in Metastatic Prostate Cancer” during the 25th Innovations in Urologic Practice conference on September 25, 2021, in Santa Fe, New Mexico.

How to cite: Yen, A. Edward. “Local Therapy – Managing Locoregional (LR) Complications in Metastatic Prostate Cancer.” September 25th, 2021. Accessed Nov 2024. https://grandroundsinurology.com/metastatic-prostate-cancer-and-role-of-treatment-to-the-primary/

Local Therapy – Managing Locoregional (LR) Complications in Metastatic Prostate Cancer – Summary

A. Edward Yen, MD, Assistant Professor of Medicine in the Hematology and Oncology Section at Baylor College of Medicine in Houston, Texas, explains the use of local therapy, meaning treatment to the primary prostate, in patients with metastatic prostate cancer. He outlines locoregional complications in these patients, calling it a significant problem and pointing out that these complications may threaten further therapy and survival. He predicts this problem may worsen due to the increasing incidence of metastatic prostate cancer and the fact that more patients are living longer with metastatic disease. Dr. Yen poses the question, “Is there a role for local therapy beyond palliation?” He describes and cites outcomes from a selection of retrospective studies that support a survival benefit associated with local therapy in metastatic prostate cancer patients. Dr. Yen then turns to the HORRAD study, whereby patients with metastatic castration-sensitive prostate cancer (mCSPC) were given androgen deprivation therapy (ADT) with or without prostate radiation. Dr. Yen analyzes the data on the study’s endpoints, overall survival (OS) and time to prostate-specific antigen (PSA) progression, which conclude there was no difference in OS but a potential benefit in those with fewer than five bone metastases and that there was a significant prolonging of the median time to PSA progression with the addition of radiation therapy (RT). Dr. Yen then describes the multi-arm, multi-stage STAMPEDE trial that looked at systemic therapy with or without RT in patients with mCSPC. The trial concluded there was no difference in OS but there was improvement in failure-free survival (FFS) for patients receiving RT. Dr. Yen points out that in the prespecified subgroup analysis, local therapy was associated with OS benefit in patients with low disease burden. He then lists ongoing studies before turning to future questions regarding local therapy in patients with metastatic prostate cancer, such as those involving patient benefit and risk factors, staging and stratification, and the effects of concurrent treatment. Dr. Yen concludes that patients receiving local therapy should be included within the context of one of the many clinical trials taking place. 

About The 25th Annual Innovations in Urologic Practice:

Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Yen presented this talk at the 2021 conference.

For further educational activities from this conference, visit our collection page.