Very High-Risk Prostate Cancer Survival Tied to Radiation Facility Volume

High-volume radiation treatment facilities contribute to better survival outcomes in men with very high-risk prostate cancer compared with low-volume centers, a new study suggests.

In the study of 25,219 men with very high-risk prostate cancer, median overall survival was significantly longer for patients treated at a center with high vs low average cumulative facility volume: 123.4 vs 109.0 months, Sagar A. Patel, MD, of Winship Cancer Institute at Emory University in Atlanta, Georgia, and colleagues reported in JAMA Network Open. On multivariable analysis, treatment at a high-volume radiation facility was significantly associated with an 11% decreased risk of death. Academic setting did not influence results.

The radiation facility volume was defined at the patient level and represents the case load and experience level of the treating facility at the time that specific patient was treated, the investigators explained. The study period was 2004 to 2016. Included men received a total radiation dose of 60 Gy or more for external beam radiation alone or 37.5 Gy or more for external beam radiation plus brachytherapy boost as first-line definitive radiation therapy. The men also received concurrent androgen deprivation therapy (ADT).

A survival benefit was observed at high-volume facilities even after adjustment for brachytherapy boost, radiation therapy fields, ADT, and chemotherapy use, the investigators reported.

According to Dr Patel’s team, “treatment for these patients with [very high-risk] prostate cancer may be nuanced, complex, and resource intensive — features that may be more readily navigated at high-volume cancer centers.”

Future studies are needed to identify which factors accounted for the survival advantage at high-volume centers. Dr Patel’s team suggested expertise in intensity-modulated radiation therapy and managing toxicity, advanced imaging, and closer collaboration among multidisciplinary team members as possible contributors. The study could not fully account for age, comorbidity burden, and socioeconomic status, which are limitations.

Very high-risk prostate cancer was defined as nonmetastatic clinical T3b-T4, primary Gleason pattern 5, more than 4 cores containing grade group 4-5 cancer, or more than 1 high-risk feature, per National Comprehensive Cancer Network criteria. The median age of the cohort was 71 years, and 78.7% were White.

Reference

Sebastian N, Goyal S, Liu Y, et al. Radiation facility volume and survival for men with very high-risk prostate cancer treated with radiation and androgen deprivation therapy. JAMA Netw Open. Published August 1, 2023. doi:10.1001/jamanetworkopen.2023.27637

This article originally appeared on Renal and Urology News