Kaldany E, Tisseverasinghe SA, Malagon T, Bahoric B, Anidjar M, McPherson V, Rompré-Brodeur A, Niazi TM. Prophylactic Α-Blockers for Radiotherapy-Induced LUTS in Men with Prostate Cancer: A Phase III Randomized Trial Analysis.
Int J Radiat Oncol Biol Phys 2023;
117:e398. [PMID:
37785330 DOI:
10.1016/j.ijrobp.2023.06.1527]
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Abstract
PURPOSE/OBJECTIVE(S)
Radiation therapy (RT) to the pelvis is one of the curative approaches for patients with localized prostate cancer. Most patients treated with prostate RT experience some degree of radiation-induced lower urinary tract symptoms (RI-LUTS). The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTS in prostate cancer patients receiving external beam radiotherapy (EBRT).
MATERIALS/METHODS
A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic Silodosin at day one of EBRT or at the time of RI-LUTS. LUTS were quantified using the International Prostate Symptom Score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT.
RESULTS
Patient demographics, baseline IPSS and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (95% CI -4.5 to 1.8, p = .40). There were no significant differences in IPSS between the study arms in the intention-to-treat (ITT) analysis at baseline, last day of RT, 4 weeks and 12 weeks post-RT. The as-treated analysis however, identified statistically significant difference at 4 weeks post-RT (95% CI -6.4 to -0.4, p = .03) in favor of prophylactic α-blockers. In an exploratory analysis, patients with prostate volumes less than or equal to 50 cc benefited at 4 weeks post-RT from prophylactic α-blocker (95% CI -8.4 to -0.3, p = .04).
CONCLUSION
Prophylactic α-blocker was not effective at significantly reducing RI-LUTS in prostate cancer patients treated with EBRT. Treating patients with α-blocker at the onset of RI-LUTS will avoid unnecessary drug exposure and toxicity. There may be a benefit for prophylactic α-blocker in patients with smaller prostate. This however, needs to be further studied in a larger study.
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