By Dr Pat Bowden, TRANSFORM Principal Investigator and Radiation Oncologist, Icon Cancer Centre
Across Australia, men diagnosed with advanced prostate cancer face difficult choices about how to treat disease that has spread beyond the prostate. For many years, the standard approach has been to start with hormone therapy, also known as androgen-deprivation therapy, and add further treatments as the disease progresses.
These treatments remain essential but can come with side effects. Unfortunately for some men, hormone therapy may lead to fatigue, loss of sexual function, bone thinning, weight gain, and changes in mood and metabolism. This can affect a man's day-to-day life and sense of wellbeing.
The Icon Cancer Centre-led TRANSFORM Trial is helping to redefine treatment for men whose prostate cancer has spread to a small number of sites outside the prostate, known as oligometastatic disease.
Challenging the traditional sequence of care
The TRANSFORM trial represents a shift in how we think about managing advanced prostate cancer, exploring whether precisely targeted radiation therapy to cancer sites beyond the prostate can delay or even avoid the need for hormone therapy, without compromising outcomes.
Nearly 200 men have been involved in the TRANSFORM trial. Each patient was treated using stereotactic radiation therapy, a highly focused form of radiotherapy that delivers high doses of radiation to cancer sites with remarkable precision, guided by advanced imaging such as PSMA-PET.
This approach allows us to directly treat small areas of disease early while sparing surrounding healthy tissue to a greater degree. The principle is simple: control what we can see, avoid the side effects that may be associated with traditional therapies, and preserve quality of life for as long as possible.
Translating precision into meaningful outcomes
After almost ten years of follow-up, the results are compelling. By using stereotactic radiation therapy, treatment escalation to hormone therapy could be delayed by two years in just over half of the participants and five years for one in four men who had not yet started hormone therapy.
It tells us that, with the right patients and high-quality imaging, stereotactic radiation therapy can be a valuable tool in the management of advanced prostate cancer.
Beyond survival: enhancing quality of life
The value of this approach is best understood through the experience of the men in the trial. One patient, first diagnosed in 2012, joined TRANSFORM in 2016 after PSMA-PET scanning revealed his cancer had spread to three sites beyond the prostate. Nearly a decade later, he continues to live an active life in good health.
Stories like his remind us of what matters most: not only prolonging survival but preserving the life that is lived. That means maintaining independence, relationships, energy, and the ability to engage fully with family and community.
By deferring hormone therapy, many men in TRANSFORM have avoided the risk of fatigue, mood change and other side-effects that can accompany long-term testosterone suppression. For them, targeted radiotherapy has meant more time feeling well, and more time being themselves.
The benefits are significant: maintaining natural testosterone levels for longer, preserving bone and muscle strength, protecting sexual health, and reducing fatigue and other complications.
The next chapter of research
While TRANSFORM has set a new benchmark, our work continues. The next phase of investigation will refine how we select patients who benefit most, how stereotactic radiation therapy can be best combined with other therapies when needed, and how emerging imaging techniques can detect and treat even smaller sites of disease earlier.
Through ongoing collaboration, we aim to build an evidence base that integrates precision radiotherapy seamlessly into the continuum of prostate cancer care.
We are proud to be demonstrating through the TRANSFORM trial that with precision radiotherapy, world-class imaging, and a focus on quality of life, men can look forward to a future defined not by their cancer, but by how fully they live beyond it.
The results of the TRANSFORM trial are published in the International Journal of Cancer. The TRANSFORM trial is supported by Icon Cancer Foundation, the not-for-profit charity that raises funds to support Icon Cancer Centre's network of doctors and healthcare professionals to do vital independent cancer research.
Dr Pat Bowden is Principal Investigator of the TRANSFORM trial and Radiation Oncologist at Icon Cancer Centre. He is committed to advancing precision radiotherapy and translating research findings into better outcomes for men with prostate cancer.
