External beam radiotherapy (EBRT) combined with a focal boost significantly improves long-term biochemical disease-free survival (bDFS) in intermediate- and high-risk prostate cancer patients, according to 10-year results from the randomized phase 3 FLAME trial.
Patients receiving EBRT plus a simultaneously integrated focal boost had an 86% bDFS rate, compared to 71% with standard EBRT, reducing biochemical failures by more than half.
The trial included 571 men with localized intermediate- and high-risk prostate cancer. Those in the focal boost group received up to 95 Gy targeted to MRI-visible lesions, while the standard group received 77 Gy to the whole gland. Beyond biochemical control, this approach also improved overall disease-free survival, local control, and regional lymph node disease-free survival at 10 years.
However, distant metastasis-free survival and overall survival rates did not differ significantly between the two groups. The study highlighted a strong correlation between radiation dose and reduced biochemical failure, with failure rates dropping to around 5% for doses above 90 Gy.
Importantly, no significant differences were observed in late genitourinary or gastrointestinal toxicity or in health-related quality of life between the treatment arms, suggesting the focal boost approach maintains safety and patient well-being.
Recent studies have supported intensified radiotherapy dosing in localized prostate cancer as a promising strategy to improve tumor control with manageable side effects, aligning with the FLAME trial findings. Advances in imaging and radiation delivery techniques have been key enablers for safely applying focal boosts.
This evidence supports integrating focal boost EBRT into treatment protocols for suitable patients with intermediate- to high-risk prostate cancer to enhance long-term control while preserving quality of life.
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