Abstract
Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan–Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27–70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58–164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103–132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials.
Highlights
The optimal treatment strategy in oligometastatic prostate cancer (PCa) patients following primary treatment is not yet determined and remains challenging [1,2]
The onset of metastatic castration-resistant PCa (CRPC) appears to be an objective endpoint and has already been shown to be a good surrogate for overall survival in post-prostatectomy patients with second biochemical recurrence following salvage RT [18]. These endpoints are economically interesting as postponement of the onset of palliative androgen deprivation therapy (ADT) and/or metastatic castration-resistant prostate cancer (mCRPC), might save a huge amount of money and improve the patient’s quality of life [19,20]. In this retrospective cohort study, we report on long-term palliative ADT-and mCRPC-free survival of oligorecurrent post-prostatectomy patients treated by metastasis-directed therapy (MDT) at our tertiary referral center
We identified 191 consecutive oligorecurrent castration-sensitive post-prostatectomy patients treated with MDT (salvage lymph node dissection, metastasectomy or radiation therapy ((SB)RT)) between 2007 and 2019 at our institution
Summary
The optimal treatment strategy in oligometastatic prostate cancer (PCa) patients following primary treatment is not yet determined and remains challenging [1,2]. With the introduction of novel imaging techniques such as choline and PSMA PET/CT at the time of biochemical recurrence (BCR), more patients are diagnosed with oligorecurrent PCa (defined as up to five lesions on imaging), leading to a shift in the treatment paradigm towards metastasis-directed therapy (MDT) [3]. The long natural history of PCa makes it difficult to determine the effect of novel treatment options on hard endpoints in clinical trials. According to the Intermediate Clinical Endpoints of Cancer of the Prostate (ICECaP) Working Group, metastasis-free survival is a good surrogate for overall survival in localized and non-metastatic castration-resistant PCa (CRPC) [4,5]. In oligorecurrent castration-sensitive PCa treated with MDT, the ideal intermediate endpoint has not yet been determined as long-term outcome data on cancer-specific and overall survival are lacking. Several retrospective and few prospective studies have shown that MDT could delay both clinical progression and the initiation of androgen deprivation therapy (ADT) in oligorecurrent
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
