Optimizing Radiotherapy QOL for Advanced Prostate Cancer Populations

Although outcomes for patients with low-risk or early-stage prostate cancer appear to be good, ongoing work seeks to improve treatment for those with advanced or potentially metastatic disease, according to Curtiland Deville Jr, MD.

Deville spoke with CancerNetwork® about how he hoped to see the radiation oncology field evolve with respect to the management of prostate cancer. In particular, he highlighted efforts related to treating patients with oligometastatic disease via novel imaging tracers that can administer focused, high-dose radiation. Although this modality may not yield curative outcomes, he described how treatment can prolong survival and extend the time to subsequent therapies such as hormonal agents or androgen deprivation therapy, which may be associated with adverse effects and detriments to quality of life.

Deville is the medical director of the Johns Hopkins Proton Therapy Center and clinical director of radiation oncology at Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital.

Transcript:

For prostate cancer, especially in early-stage disease, low-risk [disease], and what we call low-risk or intermediate-risk prostate cancer, our outcomes are very good. Cure rates and success rates are very good. [For] our patients who have more advanced disease or are just on the brink of potentially having metastasis and incurable disease, the outcomes can still be limited. Our efficacy and our cure rates can still be limited, so there’s room for improvement in terms of being able to bump up those cure rates and lower the risk of recurrence in [patients with] high-risk [disease].

We are doing well within the spectrum of what we call oligometastasis, or limited sites of spread. Our new imaging tracers, our PSMA-PET scans, are able to pick up these very small, subcentimeter—5 mm or smaller in some cases—deposits of prostate cancer in the bone or a lymph node. What we found is that delivering focused, high-dose radiation and stereotactic radiation to those areas, even if it’s not curative, can prolong the survival and prolong the interval of needing other therapies that may have more [adverse] effects, like what’s known as hormonal therapy or androgen deprivation—needing to suppress the testosterone—which has its own host of quality-of-life [adverse] effects that many of our patients [have].

If we can continue to advance some of our radiation techniques and our targeting while minimizing [adverse] effects and sparing even in other treatments, we can continue to improve and provide our patients with better quality of life as we’re managing and controlling their disease.