Abiraterone for "STAMPEDE-Like" cohort of high-risk prostate cancer in the PSMA-PET era: too much, too early?

PURPOSE

To assess long-term survival in a "STAMPEDE-like" cohort of high-risk locally advanced prostate cancer, staged with PSMA PET-CT, treated with hypofractionated radiotherapy (RT) and long-term androgen deprivation therapy (LT-ADT) without abiraterone.

MATERIALS & METHODS: Patients with non-metastatic prostate cancer fulfilling "STAMPEDE high-risk" criteria, staged with PSMA PET-CT, treated with external beam RT from 2016 to 2021 were included. RT dose was >74 Gy equivalent to prostate with LT-ADT ≥ 2 years. We analysed metastatic-free survival (MFS), prostate cancer specific survival (PCSS) and overall survival (OS) using Kaplan-Meier method.

RESULTS

170 patients were eligible, treated with hypofractionated RT with median prostate 2Gy-equivalent dose of 82 Gy. About one-third were node-positive and treated with whole pelvic RT. Over median follow up of 65 months, 6-years MFS, PCSS and OS were 80.7%, 95.8% and 94.4% respectively. On multivariate analysis, Gleason score and nodal stage showed significant association with MFS.

CONCLUSION

For PSMA-PETCT staged high risk prostate cancer, appropriately intensified local treatment could be complementary or an alternative to systemic intensification in selected patients.