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Sandy Srinivas, MD


ESMO 2023: New Insight on Treating High-Risk Prostate Cancer From 30 Years of Data

By: Celeste L. Dixon
Posted: Friday, November 10, 2023

Among patients with high-risk or locally advanced prostate cancer, those who have at least two risk factors or cN1 disease are most likely to benefit from intensified systemic therapy beyond the 18- to 36-month standard-of-care treatment of radiotherapy plus long-term androgen-deprivation therapy. This is the finding of an analysis of data on 3,604 patients—all with high-risk or locally advanced disease who received standard-of-care treatment—derived from 10 randomized controlled trials conducted by the ICECaP Consortium between 1987 and 2016. Presented at the European Society for Medical Oncology (ESMO) Congress 2023 (Abstract 1770O), these results show this patient population was likely to have a 5-year metastasis-free survival rate of less than 80%, according to Praful Ravi, MB, BChir, of Dana-Farber Cancer Institute, Boston, and colleagues.

These results should help guide patient counseling, the design of future studies, and the interpretation of adjuvant trials in high-risk or locally advanced prostate cancer, the authors suggested. In the analysis, patients were defined as having high-risk or locally advanced prostate cancer if they had one or more of the following: a Gleason score ≥ 8; ≥ cT3 disease; a prostate-specific antigen (PSA) level > 20 ng/mL; or node-positive disease. Further, metastasis-free survival was defined as distant metastasis on conventional imaging or death from any cause.

Among the study patients, the median age was 68 years; median PSA level was 24 ng/mL. Nearly three-quarters (72%) had cT3/4 disease, about half (54%) had Gleason scores of 8 to 10, and 12% had node-positive disease. “The hazard ratio for metastasis-free survival was 1.5 for [those with] Gleason [scores of] ≥ 8, 1.2 for PSA [levels of] > 20 ng/mL, 1.2 for cT3/T4, and 1.8 for node-positive disease,” reported Dr. Ravi and co-investigators. “The 5-year metastasis-free survival rates were 83%, 78%, and 77% for patients with one, two, and three risk factors, respectively, and 68% for [those with] node-positive disease.”

Disclosure: The study authors reported no conflicts of interest.

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