Matthew C. Ward, MD, radiation oncologist, Levine Cancer Institute, Atrium Health, discusses the benefits of delaying salvage therapy in prostate cancer.

Based on previous data, it is understood that approximately 50% of men with prostate cancer who meet T3 or positive-margin criteria will develop a biochemical recurrence, Ward says. However, if factors such as prostate-specific antigen (PSA) levels of at least 10 are taken into consideration, the percentage of patients who develop a biochemical recurrence is estimated to be around 20% to 25%, Ward explains. 

Studies have shown that patients treated early with salvage radiation do not derive significant benefit to adjuvant therapy; however, delaying salvage therapy until a patient has a higher PSA or prolonged period of time after recurrence can result in clinically meaningful differences in outcome between adjuvant or salvage radiation, Ward concludes.

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Matthew C. Ward, MD, discusses the benefits of delaying salvage therapy in prostate cancer. 


Dr. Ward on the Benefits of Delaying Salvage Therapy in Prostate Cancer 

Matthew C. Ward, MD, radiation oncologist, Levine Cancer Institute, Atrium Health, discusses when to consider adding systemic therapy to radiation therapy in prostate cancer. 

Patients with a high disease burden require more than radiation therapy alone, says Ward. Typically, patients with a higher burden of disease respond well to radiosensitizers, such as chemotherapy, Ward explains. 

The same is true for patients in the adjuvant and salvage settings, Ward says. Patients with high disease burden are more likely to benefit from the addition of hormone therapy to radiation therapy than radiation therapy alone.

For example, findings from the phase 3 RTOG 9601 study (NCT00002874) demonstrated significantly higher rates of long-term overall survival and lower incidences of metastatic disease with the addition of antiandrogen therapy with daily bicalutamide to salvage radiation therapy vs radiation therapy plus placebo in men with recurrent prostate cancer. Additionally, the phase 3 GETUG-AFU 16 study (NCT00423475) reported higher rates of progression-free survival with short-term androgen deprivation therapy (ADT) plus salvage radiation therapy vs radiation therapy alone in men with prostate cancer after radical prostatectomy.

More recent data suggest that patients with higher prostate-specific antigen (PSA) levels may derive more benefit from ADT compared with patients with low PSA levels, who may just derive biochemical benefit, Ward explains. As such, the addition of ADT to radiation therapy should be considered in patients with high PSA levels who are eligible for salvage radiation therapy, concludes Ward.

Matthew C. Ward, MD, discusses when to consider adding systemic therapy to radiation therapy in prostate cancer.  



Dr. Ward on Adding Systemic Therapy to Radiation Therapy in Prostate Cancer 

Matthew C. Ward, MD, radiation oncologist, Levine Cancer Institute, Atrium Health, discusses considerations for salvage radiation therapy in prostate cancer.

In considering salvage radiation for a patient with prostate cancer, it is critical to look at the patient’s pathology report, margin status, disease stage, lymph node involvement, extent of node dissection, and final Gleason score, says Ward. In addition, prostate-specific antigen (PSA) levels can inform whether salvage radiation therapy should be indicated for a patient, Ward adds. 

Patients with high PSA should receive an escalation in treatment, says Ward. However, each treatment decision requires a discussion with a patient to determine whether adding radiation therapy or androgen-deprivation therapy is optimal, Ward concludes. 

Matthew C. Ward, MD, discusses considerations for salvage radiation therapy in prostate cancer.  



Dr. Ward on Considerations for Salvage Radiation Therapy in Prostate Cancer 

Matthew C. Ward, MD, radiation oncologist, Levine Cancer Institute, Atrium Health, discusses the debate over adjuvant radiation therapy in prostate cancer. 

Ultimately, the goal of radiation therapy is to ensure a patient with prostate cancer remains disease free following prostatectomy, says Ward. Moreover, utilizing prostate-specific antigen expression as a biomarker can inform whether a patient’s disease is recurring, Ward explains. 

Adjuvant radiation therapy can offer a potentially curative approach to treating patients before they develop measurable disease, says Ward. Additionally, adjuvant radiation therapy can prevent patients from getting lost to follow-up, Ward adds. However, data suggest that about twice as many men who receive adjuvant radiation therapy are actually in need of additional therapy after surgery, Ward says. As such, overtreatment is a key point in the argument against adjuvant radiation therapy, concludes Ward.

Matthew C. Ward, MD, discusses the debate over adjuvant radiation therapy in prostate cancer.  



Matthew C. Ward, MD

Articles

Dr. Ward on the Benefits of Delaying Salvage Therapy in Prostate Cancer

Dr. Ward on Adding Systemic Therapy to Radiation Therapy in Prostate Cancer

Dr. Ward on Considerations for Salvage Radiation Therapy in Prostate Cancer

Dr. Ward on the Debate Over Adjuvant Radiation Therapy in Prostate Cancer