More men with prostate cancer can be spared radiotherapy after surgery

27 Sep 2019

More men with prostate cancer can be spared radiotherapy after surgery. The first results from the RADICALS-RT trial and the ARTISTIC meta-analysis were presented today at the ESMO Congress 2019 (Barcelona, Spain).

The RADICALS-RT trial looked at 1396 men with prostate cancer after they had surgery to remove the cancer. They were randomly allocated to receive either radiotherapy immediately after surgery, or observation only. For those patients that were under observation (the standard care group), they received radiotherapy if their prostate cancer returned.

RADICALS-RT found that after five years, 15 out of 100 men in the radiotherapy group and 12 out of 100 men in the standard care group had prostate cancer that had gotten worse. These results were compatible with chance, strengthening the case for observation after surgery, and meaning that radiotherapy would only be needed if the cancer came back.

Chris Parker (Institute of Cancer Research and Royal Marsden NHS Foundation Trust) said: “The good news is that in future, more men will avoid the side-effects of post-operative radiotherapy.”

Surgery for prostate cancer has several potential complications, including urinary leakage and narrowing of the urethra. Radiotherapy after surgery can make these complications more likely.

The ARTISTIC meta-analysis looked at three randomised trials – including RADICALS-RT - that compared immediate radiotherapy with radiotherapy only if the prostate cancer returned. ARTISTIC confirmed the results of the RADICALS-RT trial.

There were 2151 men included across the three trials (RADICALS, GETUG-AFU 17 and RAVES). 1074 men were randomly allocated to receive immediate radiotherapy and 1077 were randomly allocated to observation (with radiotherapy later if needed). The analysis found no evidence that men who received immediate radiotherapy lived longer without complications or their prostate cancer returning.

Claire Vale (MRC CTU at UCL) said: “Results of ARTISTIC provide greater evidence to support the routine use of observation and early salvage radiotherapy. It provides the best opportunity to assess whether adjuvant radiotherapy may still have a role in some groups of men, and to investigate longer term outcomes.”

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