Radiation Oncology in Prostate Cancer Is Advancing Thanks to Technology and Time

James B. Yu, MD, MHS, FASTRO, told CancerNetwork® that he believes radiation oncology is amidst a time of growth and is “getting better, faster, [becoming more] tolerated, and more effective.”

Yu, professor in the Department of Radiation Oncology and Applied Sciences, leader of the Genitourinary Radiation Oncology Program at Dartmouth-Hitchcock Medical Center, and radiation oncology editorial advisory board member of the Journal ONCOLOGY®, acknowledged that the field is in a good enough position for oncologists to argue about very miniscule differences, pointing specifically to ongoing debates between 2-, 3-, and 5- mm margins for prostate radiation.

As with many other fields, the passing of time has also allowed for more in-depth research and reporting that has already or will shortly, inform physicians of long-term results. The phase 3 PACE-B trial (NCT01584258) and the phase 3 NRG-GU005 trial (NCT03367702) are 2 such trials that Yu highlighted. The PACE-B trial found that stereotactic body radiation therapy (SBRT) elicited a 5-year incidence of freedom from biochemical or clinical failure of 95.8% (95% CI, 93.3%-97.4%) vs 94.6% (95% CI, 91.9%-96.4%) in patients who received control radiotherapy (unadjusted HR, 0.73; 90% CI, 0.48-1.12; P = .004). NRG-GU005 hasn’t yet been reported, though should be soon, according to Yu.

Transcript:

I think it’s a time for growth. Radiation treatment is getting better, faster, [becoming more] tolerated, and more effective. Technology is continuing to improve progressively, to the point where prostate radiation oncologists are now arguing between 2-, 3-, and 5- mm margins and which is better. Our ability to precisely target the prostate and prostate tumors keeps getting better year over year. Also, with time comes longer follow-up of these new technology treatments like the] long-term follow-up of patients who’ve gotten SBRT. That’s being increasingly published about. The randomized trials investigating SBRT for prostate cancer are maturing—PACE-B has reported multiple times and the US NRG-GU005 trial should report soon. The evidence for prostate radiation is growing.

Systemic therapy keeps getting better. I’ve always felt some people in radiation and surgery, are a little bit threatened by super effective systemic therapy [and think] it’s going to obviate the need for local therapy, but I disagree. The better the systemic therapy, immunotherapy, or targeted therapy, the more important a non-invasive, local treatment will be. I see a renaissance for radiosurgery and radiation in the years to come.

Reference

van As N, Griffin C, Tree A, et al. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. N Engl J Med. 2024;391(15):1413-1425. doi:10.1056/NEJMoa2403365