Treatment results of radiotherapy to both the prostate and metastatic sites in patients with bone metastatic prostate cancer

Koji Inaba, Keisuke Tsuchida, Tairo Kashihara, Rei Umezawa, Kana Takahashi, Kae Okuma, Naoya Murakami, Yoshinori Ito, Hiroshi Igaki, Minako Sumi, Yuko Nakayama, Yasuo Shinoda, Tomohiko Hara, Yoshiyuki Matsui, Motokiyo Komiyama, Hiroyuki Fujimoto, Jun Itami, Koji Inaba, Keisuke Tsuchida, Tairo Kashihara, Rei Umezawa, Kana Takahashi, Kae Okuma, Naoya Murakami, Yoshinori Ito, Hiroshi Igaki, Minako Sumi, Yuko Nakayama, Yasuo Shinoda, Tomohiko Hara, Yoshiyuki Matsui, Motokiyo Komiyama, Hiroyuki Fujimoto, Jun Itami

Abstract

Although systemic therapy is the standard treatment for metastatic prostate cancer, a randomized controlled trial showed radiotherapy to the prostate improved overall survival of metastatic prostate cancer patients with the low metastatic burden. Additionally, a randomized phase II trial showed that metastasis-directed therapy for oligo-recurrent prostate cancer improved androgen-deprivation therapy (ADT)-free survival. Therefore, administering radiotherapy to both prostate and metastatic regions might result in better outcomes. Thus, we report the treatment results of radiotherapy to both prostate and metastatic regions. Our institutional database was searched for patients who received radiotherapy to the prostate and metastatic regions. We summarized patient characteristics and treatment efficacy and performed statistical analysis to find possible prognostic factors. A total of 35 patients were included in this study. The median age was 66 years, and the median initial prostate-specific antigen (PSA) level was 32 ng/ml. The Gleason score was 7 in 10 patients, 8 in 13 patients, and 9 in 12 patients. The median radiotherapy dose was 72 Gy to the prostate and 50 Gy to the metastatic bone region. The 8-year overall survival, cause-specific survival, progression-free survival, and freedom from biochemical failure rate were 81, 85, 53, and 57%. Among the 35 patients, 12 were disease-free even after ADT was discontinued. In selected patients with metastatic prostate cancer, ADT and radiotherapy to the prostate and metastatic sites were effective. Patients with good response to ADT may benefit from radiotherapy to both prostate and metastatic regions.

Keywords: metastatic prostate cancer; prostate cancer; radiotherapy for bone metastasis; radiotherapy for both prostate and bone metastasis.

© The Author(s) 2021. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.

Figures

Fig. 1.
Fig. 1.
Freedom from biochemical failure (FFBF), progression-free survival (PFS), overall survival (OS), and cause-specific survival (CSS) for all patients.
Fig. 2.
Fig. 2.
Freedom from biochemical failure (FFBF), progression-free survival (PFS), overall survival (OS), and cause-specific survival (CSS) for the PSA level before radiotherapy ≥1 ng/ml vs

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