Abstract
Simple SummaryRecent retrospective data indicate a survival benefit of surgical removal of the prostate in patients with oligometastatic prostate cancer as part of a multimodal therapeutic regime. However, the impact of radical prostatectomy (RP) on patient’s health-related quality of life (HRQOL) in this scenario has not been evaluated yet. In a contemporary and well-balanced cohort, we compared the self-assessed HRQOL of patients with oligometastatic prostate cancer with patients with locally confined prostate cancer two years postoperatively. In multivariate analysis, we found no significant difference in postoperative HRQOL and urinary continence recovery in patients with de-novo oligo-metastatic compared to patients with locally confined prostate cancer.(1) Background: local treatment of the primary tumor has become a valid therapeutic option in de-novo oligo-metastatic prostate cancer (PC). However, evidence regarding radical prostatectomy (RP) in this setting is still subpar, and the effect of cytoreductive RP on postoperative health-related quality of life (HRQOL) is still unclear. (2) Methods: for the current study, patients with de-novo oligo-metastatic PC (cM1-oligo), defined as ≤5 bone lesions in the preoperative staging, were included, and matched cohorts using the variables age, body-mass index (BMI), and pT-stage were generated. Patient-reported outcome measures (PROMS) were assessed pre- and postoperatively using the validated EORTC-QLQ-C30, IIEF-5, and ICIQ-SF questionnaires. The primary endpoint for univariate and multivariable analysis was good general HRQOL defined by previously validated cut-off values. (3) Results: in total, 1268 patients (n = 84 (7%) cM1-oligo) underwent RP between 2012 and 2020 at one tertiary care center. A matched cohort of 411 patients (n = 79 with oligo-metastatic bone disease (cM1-oligo) and n = 332 patients without clinical indication of metastatic disease (cM0)) was created. The median follow-up was 25mo. There was no significant difference in good general HRQOL rates between cM1-oligo-patients and cM0-patients before RP (45.6% vs. 55.2%, p = 0.186), and at time of follow-up (44% vs. 56%, p = 0.811). Global health status (GHS) worsened significantly in cM0-patients compared to baseline (−5, p = 0.001), whereas GHS did not change significantly in cM1-oligo-patients (+3.2, p = 0.381). In multivariate analysis stratified for good erectile function (IIEF5 > 18; OR 5.722, 95% CI 1.89–17.36, p = 0.002) and continence recovery (OR 1.671, 95% CI 1.03–2.70, p = 0.036), cM1-oligo was not an independent predictive feature for general HRQOL (OR 0.821, 95% CI 0.44–1.53, p = 0.536). (4) Conclusions: in this large contemporary retrospective analysis, we observed no significant difference in HRQOL in patients with the oligometastatic bone disease after cytoreductive radical prostatectomy, when compared to patients with localized disease at time of surgery.
Highlights
In recent years, a plethora of systemic therapeutic options for patients with advanced prostate cancer have emerged [1,2,3,4,5,6]
Large randomized trials showed a survival benefit of radiation therapy of the primary tumor in patients with low-volume metastatic disease [7,8,9]. These data led to the recommendation of current guidelines to offer androgen deprivation therapy (ADT) combined with radiotherapy of the prostate to patients presenting with low-volume metastatic prostate cancer as part of a multimodal therapy regime [10]
Studies assessing self-reported health-related quality of life (HRQOL) showed that patients who underwent radical prostatectomy (RP) had a higher prevalence of urinary incontinence and erectile dysfunction compared to radiotherapy and observation, respectively [11]
Summary
A plethora of systemic therapeutic options for patients with advanced prostate cancer have emerged [1,2,3,4,5,6]. Large randomized trials showed a survival benefit of radiation therapy of the primary tumor in patients with low-volume metastatic disease [7,8,9]. These data led to the recommendation of current guidelines to offer androgen deprivation therapy (ADT) combined with radiotherapy of the prostate to patients presenting with low-volume metastatic prostate cancer as part of a multimodal therapy regime [10]. Considering the fact that many patients with de-novo metastatic bone-disease present with locally advanced cancer but are otherwise asymptomatic, this raises the question of whether offering cytoreductive
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