Neha Vapiwala, MD, FASTRO

Discussant of the PACE-B abstract, Neha Vapiwala, MD, FASTRO, acknowledged the impressive efforts of PACE investigators to elucidate the various treatment options for patients with localized prostate cancer—a challenging task because of the frequent absence of clear evidence. Dr. Vapiwala is Professor and Vice Chair of Radiation Oncology, and Dean of Admissions at the University of Pennsylvania Perelman School of Medicine.

As Dr. Vapiwala explained, treatment of prostate cancer in the United States should ideally be driven by appropriately executed randomized trials or top-tier evidence, which could aid both providers and patients in understanding the risks and benefits of available treatment options. The research conducted by Prof. van As and colleagues has helped to establish the safety and efficacy of ultrafractionated stereotactic body radiation therapy when compared with extended courses of treatment in patients with favorable-risk prostate cancer.

According to Dr. Vapiwala, these data may catalyze changes in the field by offering safe and effective treatment in a more convenient schedule, despite potential short-term urinary function declines.

“In the United States, we are relatively behind our colleagues on the other side of the pond in the uptake of ultrahypofractionated radiation therapy, and I believe some of that comes from a lack of feeling comfortable with the techniques needed and the expertise required,” said Dr. Vapiwala, who underscored the need for practitioners to acquire the necessary training and resources. “It’s only a matter of time before these [ultrahypofractionated regimens and radiation techniques] are increasingly adopted in the United States for clinical settings where the data support their use.”

Dr. Vapiwala continued: “As providers, we are responsible for counseling patients, andshould ensure that we present the most accurate data and help put them into context with the patient’s goals of care. Now, more than ever, we bear the responsibility to ensure patients are aware of the results from both PACE-A and PACE-B as they consider treatment options.”

Ultimately, Dr. Vapiwala predicted a promising future, where these multiple protocols will serve as valuable tools for practitioners, creating a more effective decision-making environment for patients. “The take-home message is that ultrafractionated radiation therapy delivered as described in this study is safe and effective—a high-value option for patients with favorable-risk prostate cancer. Now when you add the convenience factor and the potential cost savings of a shorter treatment course for both health systems and patients with respect to travel and time off work during treatment, it’s a no-brainer for eligible patients, in my opinion,” she concluded. 

DISCLOSURE: Dr. Vapiwala reported no conflicts of interest.