Local Failure and Survival After Definitive Radiotherapy for Aggressive Prostate Cancer: An Individual Patient-level Meta-analysis of Six Randomized Trials.

Using individual patient-level data from six randomized trials, we have found that local failure events after definitive radiotherapy for high-grade prostate cancer are independent, significant predictors of distant metastasis–free survival, prostate cancer–specific survival, and overall survival. Using multistate modeling, we identify that most distant metastatic events occur from an apparent disease-free state, but an increasing proportion occurs over time subsequent to local failure events.