Richard K. Valicenti, MD
Invited discussant of the SAKK 09/10 trial, Richard K. Valicenti, MD, of the University of California, Davis, commented: “These results bring us closer to a more individualized approach than using PSA dynamics and conventional imaging. It does not appear that historic norms are sufficient to identify a dose response. No significant difference was observed between the two approaches in relapse-free survival or genitourinary toxicity, but there was an increase in gastrointestinal toxicity with the intensified dose.”
“These data from SAKK and the Peking study are in contrast with other trials of intensified radiotherapy that had a radiographically identifiable target. If you intensify the post–radical prostatectomy dose, it is better to have a personalized target,” Dr. Valicenti said. “It does not appear that historic norms are sufficient to detect a postoperative radiation dose response…. A more individualized salvage radiotherapy strategy produces better outcomes.”
“There is evidence that individualizing radiation therapy after prostatectomy using fluciclovine positron-emission tomography [PET] to plan treatment may lead to improved failure-free survival,” he added. Dr. Valicenti noted that more sensitive imaging methods, such as fluciclovine PET or prostate-specific membrane antigen PET, may improve outcomes. “Using conventional imaging underestimates the target, making response highly unlikely,” he added.
DISCLOSURE: Dr. Valicenti reported no conflicts of interest.
A dose-intensified approach to salvage radiotherapy failed to show superiority to a conventional-dose strategy in patients with biochemically recurrent prostate cancer who had undergone radical prostatectomy, according to the phase III SAKK 09/10 trial presented at the 2021 Genitourinary Cancers...