Prostate radiotherapy in newly diagnosed metastatic prostate cancer.
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<h4>Purpose of review</h4>The aim of this article is to review the role of prostate radiotherapy in the multimodal management of newly diagnosed metastatic hormone naïve prostate cancer.<h4>Recent findings</h4>Two randomized controlled trials have evaluated the role of prostate radiotherapy with systemic therapy (androgen deprivation therapy ± docetaxel) in newly diagnosed metastatic hormone-naive prostate cancer. In a combined cohort of over 2000 patients, prostate radiotherapy with systemic therapy improved survival over systemic therapy alone in patients with low metastatic burden but not in high-burden patients. Prostate radiotherapy with systemic therapy is now a recommended first-line option for newly diagnosed men with low metastatic burden prostate cancer. The current recommended definition for low metastatic burden is based on conventional imaging (Tc bone scans and CT/MRI). Cross-correlative studies are required to pick an appropriate threshold for sensitive-imaging modalities such as PSMA PET or whole-body MRI. Ongoing trials are evaluating prostate radiotherapy in this setting combined with abiraterone/docetaxel and metastasis-directed therapy.<h4>Summary</h4>Prostate radiotherapy with systemic therapy improves survival in patients with newly diagnosed, low metastatic burden prostate cancer and is a recommended first-line treatment option. Ongoing trials are evaluating combination with metastasis-directed therapy and other systemic treatments.
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Randomized Controlled Trials as Topic
Current opinion in urology, 2019, 29 (6), pp. 620 - 628