(UroToday.com) The 2025 ASTRO annual meeting featured a metastatic prostate cancer session and a presentation by Dr. Huizhu Chen discussing efficacy and safety of all-site radiation therapy and standard of care therapy with or without docetaxel for hormone-sensitive high Gleason score prostate cancer. ADT, novel hormonal therapy, and prostate radiation therapy have become the standard treatment for metastatic hormone-sensitive prostate cancer. However, for high Gleason score prostate cancer, more intensive systemic and local treatment strategies may be required. The objective of this study is to evaluate the efficacy and safety of combining all-site radiation therapy, with or without docetaxel chemotherapy, in conjunction with standard of care therapy for high Gleason score metastatic hormone-sensitive prostate cancer.
This study consecutively enrolled patients from 2018 to 2024 diagnosed with prostate adenocarcinoma (Grade Group 5 or including a 5-score component). All participants had confirmed distant metastases via imaging and were in the hormone-sensitive prostate cancer stage before radiation therapy. Patients were assigned to either a standard of care (ADT + novel hormonal therapy) + all-site radiation therapy group, or a standard of care + all-site radiation therapy + docetaxel group. The radiation therapy protocol included all-site radiation or targeting all residual sites following systemic therapy. The primary endpoints were radiographic progression-free survival and overall survival. Secondary endpoints included disease-specific survival, PSA progression-free survival, castration resistant prostate cancer-free survival, time to new anti-cancer treatment, skeletal event-free survival, and urinary symptom deterioration-free survival.
There were 166 patients included, 39 in the standard of care + all-site radiation therapy + docetaxel group and 127 in the standard of care + all-site radiation therapy group:
The median age was 67 (46-89) years, and the median follow-up time was 18.2 (0.8-76.8) months, including 72 (43.4%) with high tumor burden:
The 5-year radiographic progression-free survival was significantly better with docetaxel (71.8% versus 47.9%; HR 0.24, 95% CI 0.08-0.70; p = 0.037). There were 78 patients obtained using 1:1 propensity matching based on 10 baseline characteristics, including metastasis type, tumor burden, and other variables. In the matched population, the standard of care + all-site radiation therapy + docetaxel group had significantly better 5-year radiographic progression-free survival (p = 0.0096), which was also seen in an IPTW analysis (p = 0.015):
Subgroup analyses suggested a significant benefit in radiographic progression-free survival for patients with high tumor burden (HR 0.28, 95% CI 0.09-0.83) and synchronous metastasis (HR 0.42, 95% CI 0.15-1.18):
Dr. Chen concluded her presentation discussing the efficacy and safety of all-site radiation therapy and standard of care therapy with or without docetaxel for hormone-sensitive high Gleason score prostate cancer with the following take-home points:
- Adding docetaxel to the standard of care + all site radiotherapy during the metastatic hormone-sensitive prostate cancer stage for high Gleason Score patients confers a greater radiographic progression-free survival
- Adverse reactions in both treatment groups were tolerable
- These findings warrant larger prospective or randomized controlled trials to confirm the benefits and explore the impact on long-term overall survival
Presented by: Huizhu Chen, MD, Peking University First Hospital, Beijing
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 American Society for Radiation Oncology (ASTRO) Annual Meeting, San Francisco, CA, Sat, Sept 27 – Wed, Oct 1, 2025.