Treatment of Prostate Cancer: Lessons Learned from High Impact Randomized Trials with Dr. Mira Keyes

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Published Nov 21, 2025

Mira Keyes, MD, FRCPC, FABS, British Columbia Cancer Agency, Vancouver, British Columbia, Canada, outlines advancements in radiation therapy for prostate cancer. In this 17-minute presentation, Dr. Keyes focuses on dose escalation, salvage radiation, and brachytherapy.

Dr. Keyes explains that increasing radiation doses improves biochemical-free survival but raises toxicity risks. Technological advancements such as VMAT, image guidance, and rectal spacers address this. Dr. Keyes cites the FLAME trial, which demonstrated improved biochemical control by boosting MRI-visible lesions with a higher dose, and the HYPO-FLAME trial, which further explores extreme hypofractionation using SBRT.

Dr. Keyes references the ASCENDE-RT trial, which revealed that combining brachytherapy with external beam radiation dramatically lowers recurrence rates. She also shares results from the PACE B trial, demonstrating that SBRT in five sessions offers comparable outcomes to conventional radiation with acceptable toxicity. Dr. Keys asserts that while proton therapy may reduce secondary malignancies, its cost remains a consideration. She also shares that early intervention at lower PSA levels in salvage radiation improves outcomes.

This comprehensive overview emphasizes tailoring treatment strategies to optimize outcomes in prostate cancer management.

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