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Radiation and hormone therapy may replace chemotherapy for prostate cancer
Last reviewed: 02.07.2025
Radiotherapy could be used alongside hormone therapy, delaying the need for chemotherapy and significantly improving the quality of life of some patients with advanced prostate cancer, according to a study led by researchers from The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London.
The results of the TRAP (Targeting Hormone-Resistant Metastases with Radiotherapy) study were presented at the annual congress of the European Society for Radiotherapy and Oncology (ESTRO).
Treatment of advanced cancer
This phase II study is the first prospective trial investigating the use of stereotactic body radiation therapy (SBRT) in patients with hormone-refractory oligoprogressive prostate cancer. Oligoprogressive cancer occurs when cells from the original tumor travel to fewer than three sites in the body, forming new tumors or lesions.
Currently, disease progression after hormonal therapy is considered a sign that the cancer has become resistant to treatment. However, the study results showed that only some tumors may be resistant, and if these tumors are treated with radiotherapy, the rest of the cancer will continue to respond to hormonal therapy.
The study showed that patients' cancer remained progression-free for an average of six months (6.4), and 40.1% of patients remained progression-free for 12 months.
SBRT and Hormonal Therapy Study
In a national study conducted in cancer centres across the UK, researchers looked at whether giving SBRT along with androgen receptor targeted agents to patients with advanced prostate cancer could delay the progression of their disease.
SBRT, which can be performed on CyberKnife or standard radiation therapy machines, allows doctors to precisely target tumors with submillimeter accuracy. This approach uses advanced imaging and treatment planning techniques to deliver radiation with precision while minimizing damage to surrounding healthy tissue.
40% of men had no signs of cancer growth within 12 months
The patients in the study had advanced prostate cancer that was no longer responding to conventional treatment. They had no more than two new lesions of cancer that developed during the two types of hormonal therapy after an initial good response to treatment. All patients received five or six SBRT sessions, which were painless and took about 20 to 30 minutes each.
A total of 81 men received SBRT, and the majority (67%) had a single oligoprogressive tumor. Treatment sites included bone (59%), lung (1%), lymph nodes (32%), and prostate (8%).
After a median of 19.2 months, 53 (65%) patients had disease progression; 32 (40%) progressed within six months of SBRT treatment. Median progression-free survival after SBRT was 6.4 months, and 40% of men had no evidence of cancer growth 12 months after treatment.
PSA levels may indicate the effectiveness of SBRT
PSA levels, in the context of prostate cancer, refer to the level of prostate-specific antigen in the blood, a marker secreted by the prostate and elevated by cancer. Among 43 men whose PSA results were available three months after SBRT and whose cancer had not progressed at six months, 84% had a significant decrease in PSA. This compared with 45% of those who had progressed or died at six months. So PSA seems to be a good predictor of the long-term effectiveness of SBRT.
Further research
The treatment is now being studied as part of the STAR-TRAP trial, led by Dr Julia Murray at The Royal Marsden NHS Foundation Trust, with the hope that the findings will help change the standard of care for patients with advanced prostate cancer.
Hope to delay the need for chemotherapy
Dr Alison Tree, consultant clinical oncologist at The Royal Marsden NHS Foundation Trust, Honorary Reader at The Institute of Cancer Research and principal investigator of the TRAP trial, said: "These initial results could be great news for patients with advanced prostate cancer. We are committed to developing smarter, kinder and more effective treatments for patients in the UK and around the world.
"Currently, treatment options for men with advanced prostate cancer are limited, but I am hopeful that once larger studies are conducted to confirm our findings, we will see a change and be able to treat these patients differently, using radiotherapy as the standard to target drug-resistant parts of the cancer.
"Radiotherapy is well tolerated and significant side effects are rare, so we hope that this treatment will delay the need for chemotherapy in the future, prolonging quality of life."
Simon Grieveson, assistant director of research at Prostate Cancer UK, said: "Radiotherapy can be an extremely effective treatment for men with early stage, localised prostate cancer, however we have funded the TRAP trial to look at the use of radiotherapy in men whose cancer has spread to other parts of the body.
"These results are very promising and suggest that targeting radiotherapy to areas where cancer has spread may delay further disease progression and the need for subsequent treatments such as chemotherapy.
"While these results offer great promise for men with advanced prostate cancer who are beginning to run out of treatment options, this now needs to be tested in a larger randomised trial, and Prostate Cancer UK is funding the STAR-TRAP trial to achieve this."