Richard K. Valicenti, MD, MA, FASTRO
Discussant of the SPPORT trial abstract at the ASTRO Annual Meeting, Richard K. Valicenti, MD, MA, FASTRO, Chair and Professor of Radiation Oncology at the University of California Davis Comprehensive Cancer Center, commented that the interim results of this study along with data from other randomized trials provide a new clinical standard for the use of androgen-deprivation therapy with salvage postprostatectomy radiation therapy.
“Based on this evidence, we should be offering short-term [androgen-deprivation therapy] to our patients with rising [prostate-specific antigen level] with negative conventional imaging,” said Dr. Valicenti. “However, I think the use of pelvic radiotherapy awaits additional evaluation.”
Although a strategy of pelvic radiotherapy with androgen-deprivation therapy and prostate bed radiotherapy appears beneficial in comparison to prostate bed radiotherapy only, said Dr. Valicenti, the advantage requires additional study or may be justified only for selected patients. “We’ve got to see whether that’s more of a benefit from local tumor control or a benefit from a better coverage of the spread at the clinical base,” he observed.
“For the time being, I think clinical decision-making is going to come down to what we value more,” Dr. Valicenti added. “Do we value the results of a high-quality, randomized, prospective trial when making clinical decisions, or are we more comfortable with the unfamiliar findings on [positron-emission tomography] imaging, whose impact on outcome is unknown?” ■
DISCLOSURE: Dr. Valicenti reported no conflicts of interest.
For patients with prostate cancer who have persistent or rising prostate-specific antigen (PSA) levels after radical prostatectomy, the addition of short-term androgen-deprivation therapy and radiotherapy to the pelvic lymph nodes demonstrated increased rates of freedom from disease progression,...