ADT/ARPI/radiotherapy combo appears efficacious in mHSPC

In this video, Scott Morgan, MD, MSc, FRCPC, shares the take-home message from the European Urology paper, “Prostate Radiotherapy in Low-volume Metastatic Hormone-sensitive Prostate Cancer: A Network Meta-analysis.” Morgan is a radiation oncologist at The Ottawa Hospital Cancer Centre and an associate professor of radiation oncology at the University of Ottawa, Ontario, Canada.

Transcription:

What is the take-home message for the practicing urologist?

From our point of view, I think the takeaway for the clinician practicing in this area, be it the urologist or the medical oncologist or the radiation oncologist, is that in patients with de novo metastatic prostate cancer and low metastatic burden—and we can debate exactly how you define low metastatic burden—but in any case, if you can reach a consensus on that, I think a combination of ADT, an AR pathway inhibitor, and prostate radiotherapy appears to confer better overall survival than a strategy in which the prostate radiotherapy is omitted. So I think that the combination of the 3 therapies, given the evidence base at present, is the approach that is best supported. There are some limitations to the existing evidence base, and ideally, a large-scale randomized trial would address this question. But while we're awaiting such a randomized trial, or while we're awaiting an individual patient data meta-analysis, I think this is the preferred treatment approach in patients presenting with low-volume metastatic disease. Another takeaway, I think, which is less important than the main takeaway, but another takeaway is that in clinical scenarios where use of an AR pathway inhibitor is not possible due to comorbidity concerns, or whether there's a lack of availability of an ARPI—which, admittedly, is not a particularly common scenario in North America—but I think in that scenario...the combination of ADT and prostate radiotherapy is a reasonable alternative in patients with low-volume metastatic disease, and I think, based on this analysis, at least, would appear to confer similar outcomes in terms of overall survival. Prostate radiotherapy is obviously widely available, inexpensive, generally a mild toxicity profile. So I think it's a reasonable option in that scenario in patients who present with de novo low-volume disease.

This transcription was edited for clarity.