Cytoreductive radical prostatectomy in patients with prostate cancer and low-volume skeletal metastases: Results of a feasibility and case-control study.

Abstract

176 Background: Androgen deprivation (ADT) represents the standard treatment for PCA with osseous metastases. We explored the role of cytoreductive radical prostatectomy in PCA with low volume skeletal metastases in terms of a feasibility study. Methods: 32 patients with biopsy proven PCA, minimal osseous metastases (≤ 3 hot spots on bone scan), absence of visceral or extensive lymph node metastases and PSA decrease to < 1.0 ng/ml after neoadjuvant ADT were included in the feasibility study. 38 men with metastatic PCA who were treated by ADT without local therapy served as control group (group B). Surgery-related complications, biochemical progression-free, symptomatic-free, cancer-specific and overall survival were analyzed using descriptive statistical analysis. Results: Mean age was 61 (42-69) and 64 (47-83) years in group A and B, respectively, with similar patient characteristics in terms of initial PSA, biopsy Gleason score, clinical stage, extent of metastatic disease. The mean follow-up was 40.6 (3-71) and 44 (24-96) months in group A and B, respectively. Pathohistology revealed vital PCA with metastatic potential in all 32 patients despite neoadjuvant ADT. 12% of pts in group A developed Clavien grade III complications. According to the ICSmaleSF questionnaire 30/32 (93.7%) pts were continent. Patients in group A experienced significantly better bPFS (36.8 versus 23.1 months, p=0.042), clinical PFS (38.6 versus 26.5 months, p=0.032) and cancer specific survival rate (95.6% versus 84.2%, p=0.043) whereas the overall survival was similar. 0% and 29% of men in group A and B, respectively, underwent palliative surgical procedures for locally progressing PCA. Conclusions: CRP is feasible with good functional and oncological results in well selected men with metastatic PCA who respond well to neoadjuvant ADT. These men have a long life expectancy and CRP reduces the risk of locally recurrent PCA and local complications. CRP might be a treatment option in the multimodality management of PCA with minimal osseous metastases.