MP79-16 LONG-TERM RESULTS OF CYTOREDUCTIVE RADICAL PROSTATECTOMY IN MEN WITH HORMONE-NAIVE, LOW VOLUME METASTATIC PROSTATE CANCER(MHNPCA)

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) IV (MP79)1 Apr 2020MP79-16 LONG-TERM RESULTS OF CYTOREDUCTIVE RADICAL PROSTATECTOMY IN MEN WITH HORMONE-NAIVE, LOW VOLUME METASTATIC PROSTATE CANCER(MHNPCA) Patricia John*, David Pfister, Axel Heidenreich, and Florian Hartmann Patricia John*Patricia John* More articles by this author , David PfisterDavid Pfister More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , and Florian HartmannFlorian Hartmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000971.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Androgen deprivation combined with apalutamide, abiraterone or docetexal represents the treatment of choice in mhnPCA. Cytoreductive radical prostatectomy (cRP) has been proposed as part of a multimodality treatment in selected patients with oligometastatic prostate cancer. Recently, our group has demonstrated that the combination of 6 months neoadjuvant ADT followed by cRP exerted a significant benefit in terms of progression-free, local symptom-free survival and time to castration resistance. We report on the long-term outcome of this cohort of men with low volume mhnPCA. METHODS: 32 patients with hnmPCA were retrospectively analysed. All men had low volume skeletal metastases (≤3 lesions on a bone scan), absence of visceral and retroperitoneal lymph node metastases, and a PSA-decrease <1,0 ng/ml following 6 months of ADT. 38 case-matched patients with mhnPCA and ADT monotherapy served as a control group. Perioperative complications were assessed according to Clavien-Dindo, PSA-free, symptom-free, cancer specific and overall survival was analysed and assessed via descriptive statistics. RESULTS: Mean age of the patients was 61 (42–69) years. Mean PSA at time of diagnosis was 135.2 (3.5-150.4) ng/ml, the mean PSA at time of cRP was 0.42 (0.01-9.8) ng/ml. All patients demonstrated a mean of 2.1 (1-3) osseous metastases, intrapelvic lymph node metastases were identified preoperatively in 17.4% of patients. All men underwent cRP and extended pelvic lymphadenectomy. The median follow-up is 75,5 (7–135) months, 27/32 (84.4%) patients are still alive. 16/27 (59.2%) have developed mCRPC. Median overall survival is 78.9 months and the median time to CRPC is 40 (9–65) months. Overall survival, progression-free survival and time to CRPC was significantly superior in the cRP group as compared to ADT alone (p = 0.003). 10 (31.2%) patients developed perioperative complications of whom only 3/32 (9.4%) patients required interventions and were defined as Clavien-Dindo IIIa/b. 28/32 (87.5%) patients are continent (0-1 pads/day). None of the patients developed locally symptomatic relapses after cRP whereas this was the case in 12 (31.6%) pts in the ADT alone group. CONCLUSIONS: Even after long-term follow-up neoadjuvant ADT and cRP result in good oncological and functional outcome with a 6-year overall survival rate of more than 80%. As compared to about 25% symptomatic local relapses following radiation therapy and to 31% relapses following ADT alone, none of the patients developed symptomatic local relapses following cRP. Although data from prospective randomized trials are lacking, cRP should be considered as a valid treatment option in well selected patients with low volume metastatic disease and good response to neoadjuvant ADT. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1221-e1222 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patricia John* More articles by this author David Pfister More articles by this author Axel Heidenreich More articles by this author Florian Hartmann More articles by this author Expand All Advertisement PDF downloadLoading ...