Re: Bo Dai, Sheng Zhang, Fan-Ning Wan, et al. Combination of Androgen Deprivation Therapy with Radical Local Therapy Versus Androgen Deprivation Therapy Alone for Newly Diagnosed Oligometastatic Prostate Cancer : A Phase 2 Randomized Controlled Trial. Eur Urol Oncol 2022;5:519–25

Abstract

Dai et al [[1]Dai B. Zhang S. Wan F.N. et al.Combination of androgen deprivation therapy with radical local therapy versus androgen deprivation therapy alone for newly diagnosed oligometastatic prostate cancer : a phase II randomized controlled trial.Eur Urol Oncol. 2022; 5: 519-525https://doi.org/10.1016/j.euo.2022.06.001Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] recently reported on a prospective phase 2 study assessing the impact of radical prostatectomy (RP) in patients with oligometastatic hormone sensitive prostate cancer (PCa). The study randomized 200 patients to androgen deprivation therapy (ADT) alone or ADT plus local therapy (RP in approximately 90% of the cases) and suggested that the latter treatment approach was associated with a survival advantage. We recognize the criticisms by Blanchard and Vickers [[2]Blanchard P. Vickers A.J. Prostatectomy in patients with oligometastatic hormone-sensitive prostate cancer? Not yet.Eur Urol Oncol. 2022; 5: 526-527https://doi.org/10.1016/j.euo.2022.07.005Abstract Full Text Full Text PDF Scopus (0) Google Scholar] in their accompanying editorial and we agree on the need for rigorous statistical methods when designing prospective studies. We value the opinion by Graefen and Joniau [[3]Graefen M. Joniau S. Radical prostatectomy or radiotherapy in oligometastatic prostate cancer : is it nearly time to call it a draw ?.Eur Urol Oncol. 2022; 5: 528-529https://doi.org/10.1016/j.euo.2022.08.004Abstract Full Text Full Text PDF Scopus (0) Google Scholar] expressed in a second laudable editorial that goes against the concept that RP should be considered investigational in this particular subset of patients. We respectfully suggest that radiation therapy and RP should be considered allies when dealing with PCa patients, including those who present with locally advanced or oligometastatic disease. From the eyes of a surgeon with solid experience in PCa, radiation therapy represents the most valuable option in patients who are significantly overweight—and not necessarily just those who are morbidly obese—and in frail men. Sometimes we see men with PCa who fall into one of these two categories and are referred to us for a second opinion after a recommendation to undergo surgery, and it becomes clear that the patients and their families were not even counseled on the risks of postoperative sequelae. Even worse, in many cases the option of radiation therapy was either not discussed or was described as not being as efficient as surgery by the urologist. We, as surgeons, should do our best to provide our patients with the best surgical technique possible. However, we should realize that the first and most important pillar in leading to clinical success is selecting the most optimal therapeutic modality for each case. At our center, a young and fit patient who is slim or ready to follow a low-calorie diet to reach the optimal weight would be informed and counseled regarding the potentials and limitations of RP, which can be of great value, especially for those who have obstructive urinary symptoms. An experienced radiation therapist also sees every single PCa patient and expresses views regarding treatment options for the individual. By following this strategy, every patient is offered the opportunity to make his own well-informed decision on what therapy to follow. Conflicts of interest: The authors have nothing to disclose.