PARTIQoL: phase 3 randomised trial of proton therapy versus IMRT for localised prostate cancer (ASTRO 2024 late-breaking abstract)
In the first multicentre randomised comparison of protons and IMRT for localised prostate cancer, bowel, urinary and sexual quality of life and five-year cancer control were the same with either technique.
Overview
Late-breaking abstract LBA01 at the 2024 ASTRO Annual Meeting, published in the meeting supplement of the International Journal of Radiation Oncology, Biology, Physics. PARTIQoL (NCT01617161) randomised 450 men with low- or intermediate-risk localised prostate cancer at 29 centres between June 2012 and November 2021 to proton beam therapy or intensity-modulated radiotherapy, without hormone therapy, stratified by institution, age, rectal spacer use and fractionation. The primary endpoint was the change in EPIC bowel quality of life at 24 months.
With a median follow-up of 60.3 months, bowel scores declined only slightly in both arms: from 93.7 to 91.8 with protons and from 93.5 to 91.9 with IMRT at 24 months (p=0.836), a difference that was neither statistically significant nor clinically meaningful. Urinary incontinence, urinary irritation and sexual function did not differ at any time point, and there were no sustained differences in subgroups by risk group, age, rectal spacer or fractionation. Five-year progression-free survival was 93.4% with protons and 93.7% with IMRT (p=0.706). This record carries the abstract's figures only.
- EPIC bowel quality of life at 24 months 91.8 with protons vs 91.9 with IMRT (baseline 93.7 and 93.5); p=0.836 for the primary endpoint.
- No significant differences in urinary incontinence, urinary irritation or sexual function at any time point over 60 months.
- Five-year progression-free survival 93.4% with protons vs 93.7% with IMRT (p=0.706).
- Median follow-up 60.3 months; 450 men randomised at 29 centres, median age 68.
For men with low- or intermediate-risk prostate cancer, protons and modern IMRT give the same excellent quality of life and cancer control, so the choice can rest on access, cost and convenience rather than on an expected sparing of bowel or bladder. The result removes prostate cancer from the list of adult indications where a proton advantage was assumed but untested.
- Abstract figures only; the peer-reviewed full paper carries the definitive numbers.
- Patient-reported quality of life was the primary endpoint, not toxicity graded by clinicians or long-term second cancers.
- Low- and intermediate-risk disease without hormone therapy; high-risk and node-positive disease were not studied.
- Rectal spacers and hypofractionation were allowed in both arms, which may have narrowed any difference.
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