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Purpose/objective(s) <p>For patients who have received standard systemic treatment during the metastatic hormone-sensitive prostate cancer (mHSPC) stage, the optimal timing of radiotherapy (RT) is still not clear. We compared the efficacy and safety of early RT (≤ 6&#xa0;months after systemic therapy initiation) versus delayed RT (&gt; 6&#xa0;months) in high Gleason Score patients.</p> Materials/methods <p>Patients with high Gleason Score prostate cancer receiving standard systemic therapy in the metastatic hormone-sensitive phase followed by metastasis-directed radiotherapy (MDT, RT to all detectable lesions) from 2018 to 2025 were included. Patients were categorized into early RT (≤ 6&#xa0;months) and delayed RT (&gt; 6&#xa0;months) groups. Inverse probability of treatment weighting (IPTW) balanced baseline characteristics. The primary endpoint was castration-resistant prostate cancer-free survival (CRPCFS) analyzed by IPTW-weighted Cox models.</p> Results <p>Among 196 patients, 190 were analyzed (65 early RT, 125 delayed RT). IPTW achieved generally good balance in measured baseline covariates. Median follow-up was 33.1&#xa0;months. Early RT significantly improved CRPCFS (HR 0.172, 95% CI 0.063–0.469, <i>P</i> = 0.001), with 5-year CRPCFS rates of 71.1% vs. 44.0%. Results were consistent in multivariable and competing risk analyses. Early RT also improved PFS (<i>P</i> = 0.007), PSAPFS (<i>P</i> = 0.002), and OS (<i>P</i> = 0.018), with benefits consistent across tumor volume subgroups (P-interaction = 0.191). Sensitivity analyses confirmed robustness.</p> Conclusion <p>Earlier RT was associated with improved CRPCFS, with favorable signals in secondary outcomes. These findings warrant prospective evaluation of RT timing in high Gleason score mHSPC.</p>

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Impact of early vs. delayed metastasis-directed therapy on clinical outcomes in high Gleason score metastatic prostate cancer: long-term results of a landmark cohort study (PROMPT-G)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • Huizhu Chen,
  • Xueying Ren,
  • Yun Bai,
  • Jiayan Chen,
  • Wei Yu,
  • Kaiwei Yang,
  • Xiaoying Li,
  • Shangbin Qin,
  • Mingxia Sun,
  • Xuesong Li,
  • Hongzhen Li,
  • Xianshu Gao,
  • Mingwei Ma

摘要

Purpose/objective(s)

For patients who have received standard systemic treatment during the metastatic hormone-sensitive prostate cancer (mHSPC) stage, the optimal timing of radiotherapy (RT) is still not clear. We compared the efficacy and safety of early RT (≤ 6 months after systemic therapy initiation) versus delayed RT (> 6 months) in high Gleason Score patients.

Materials/methods

Patients with high Gleason Score prostate cancer receiving standard systemic therapy in the metastatic hormone-sensitive phase followed by metastasis-directed radiotherapy (MDT, RT to all detectable lesions) from 2018 to 2025 were included. Patients were categorized into early RT (≤ 6 months) and delayed RT (> 6 months) groups. Inverse probability of treatment weighting (IPTW) balanced baseline characteristics. The primary endpoint was castration-resistant prostate cancer-free survival (CRPCFS) analyzed by IPTW-weighted Cox models.

Results

Among 196 patients, 190 were analyzed (65 early RT, 125 delayed RT). IPTW achieved generally good balance in measured baseline covariates. Median follow-up was 33.1 months. Early RT significantly improved CRPCFS (HR 0.172, 95% CI 0.063–0.469, P = 0.001), with 5-year CRPCFS rates of 71.1% vs. 44.0%. Results were consistent in multivariable and competing risk analyses. Early RT also improved PFS (P = 0.007), PSAPFS (P = 0.002), and OS (P = 0.018), with benefits consistent across tumor volume subgroups (P-interaction = 0.191). Sensitivity analyses confirmed robustness.

Conclusion

Earlier RT was associated with improved CRPCFS, with favorable signals in secondary outcomes. These findings warrant prospective evaluation of RT timing in high Gleason score mHSPC.