Individualized radiotherapy of bone metastases from prostate cancer: time trends and 5-year survival results

PURPOSE: This article describes a regional study performed in patients with bone metastases from prostate cancer hypothesizing that intensified radiotherapy (metastases directed and prostate directed) may result in longer overall survival. METHODS: A retrospective study of 246 consecutive male patients who received 347 courses of radiotherapy in the time period 2011-2025 was performed. Patients were stratified into three cohorts spanning 5‑year intervals (2011-2015, 2016-2020, 2021-2025). Survival was analyzed in allcomers and separately in patients without visceral metastases treated within the first year after diagnosis (n = 119). RESULTS: Median overall survival was shortest in the earliest phase of the study (2011-15). The two recent cohorts had similar survival. Outpatients with high performance status irradiated early after diagnosis and to all known sites of disease experienced superior survival. In the subgroup of 119 patients, simultaneous prostate radiotherapy prolonged survival (numerically better than no prostate RT, median 40 vs. 26 months, 5‑year rate 47 vs. 18%, p = 0.11). The impact of bone radiotherapy dose (dichotomized < 3 Gy × 13 or its biological equivalent vs. higher doses) was significant (if synchronous metastases, 5‑year rate 64 vs. 17%, p = 0.026; if metachronous metastases, 5‑year rate 48 vs. 8%, p < 0.001). Bone dose remained significant in multivariate analyses, together with clinical baseline parameters. CONCLUSION: In our healthcare region, outcomes largely resemble those of prospective trials. Comprehensive radiotherapy to the prostate and bone oligometastases plus guideline-based systemic therapy resulted in favorable 5‑year survival.