"Prostate radiotherapy improves the survival of men with metastatic prostate cancer who have a low disease burden," reported Parker. He recommended: "Prostate radiotherapy, in addition to drug treatment, should now be a standard treatment option for men with oligometastatic disease."

Parker noted that prostate radiotherapy is a simple technique that is widely available and relatively cheap, so he considered that it can be implemented easily. He added that the study results are also relevant to men with pelvic node positive but non-metastatic disease (N1M0) where addition of radiotherapy to drug treatment could be curative.


Commenting on the findings for ESMO, Prof. Karim Fizazi, from the Gustave Roussy Institute, University of Paris Sud, France, said: "For the first time, this study provides evidence that treating the local primary tumor is associated with improvement in overall survival in men with metastatic prostate cancer and minimal disseminated disease." He added that the finding that there was no significant increase in overall survival in men with higher burden of disease was in line with the previously reported HORRAD trial (3).

Considering the implications for clinical practice, Fizazi suggested: "For men with newly diagnosed oligometastatic prostate cancer, it is quite likely that this data is practice changing." Looking to the future, he said: "For men with higher burden of disease more data are needed regarding whether upfront local treatment improves or prevents local symptoms, which, by itself, may justify its use in the absence of an overall survival benefit."

In terms of limitations, Fizazi noted that although the study was a large, randomised phase 3 trial only 18% of the patients had received early docetaxel and none had received early abiraterone, although these treatments are now part of standard treatment in fit men.

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