You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) IV1 Apr 2018MP87-19 MULTIMODAL SYSTEMIC THERAPY WITH DEFINITIVE PROSTATECTOMY IN DE NOVO METASTATIC PROSTATE CANCER Ramkishen Narayanan, Jennifer Linehan, Nicholas Vogelzang, Chikako Matsuba, Przemyslaw Twardowski, and Timothy Wilson Ramkishen NarayananRamkishen Narayanan More articles by this author , Jennifer LinehanJennifer Linehan More articles by this author , Nicholas VogelzangNicholas Vogelzang More articles by this author , Chikako MatsubaChikako Matsuba More articles by this author , Przemyslaw TwardowskiPrzemyslaw Twardowski More articles by this author , and Timothy WilsonTimothy Wilson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2919AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Whether definitive treatment of the prostate should be a part of metastatic prostate cancer (mPC) management is unknown; SWOG 1802 randomized phase III trial is pending activation to help answer this question. We report on a series of men presenting with hormone sensitive mPC who received multimodal systemic therapy (MST) followed by radical prostatectomy (RP). METHODS Using ICD-10 PC code filter, we reviewed 975 patient records from 9/2014-9/2017 at a tertiary referral center. We identified 20 men who presented with mPC (M1a-b) treated with standard of care (SOC) systemic therapy then RP. None had visceral metastases. SOC systemic therapy was multimodal: androgen deprivation therapy (ADT) plus other approved agents for mPC added sequentially and/or switched (for side effects or at physician discretion) toward the goal of PSA annihilation prior to consideration of RP. We used the established PCWG2 definition of PSA failure (PSAF). RESULTS Table 1 provides clinicopathologic data for each of the 20 patients; 70% White and 55% PC family history. 50% with high (H) metastatic burden i.e. ≥4 skeletal metastases with ≥1 beyond vertebral bodies and pelvis. 85% (17/20) received systemic chemotherapy before RP. Median overall follow-up (f/u): 28.8 months (range 11.7 - 61.6 mos); all men alive as of last f/u. Median age at surgery: 66 yo (range 39 - 78 yrs). 90% had robotic surgery. We note robotic RP was aborted in 1 patient (excluded from cohort). No grade 4 or 5 complications were observed; 2 patients had grade 3 complications needing drainage: 1) pelvic abscess 2) urine leak with ascites and enteritis. 5/20 (25%) men had pT0 status at RP: all had pre-RP PSA <0.1; median time from diagnosis (DX) to RP = 12.5 mos. 7/20 (35%) patients had post-RP PSA failure (PSAF): median time from DX to RP = 15.9 mos. PSAF men had more median tumor involvement in RP specimen (25% v. 1%, p=0.028, Mann-Whitney U test). CONCLUSIONS Definitive RP following SOC systemic therapy is safe and appears to be largely feasible robotically. Post-RP urinary QOL was comparable to RP for localized disease (with extrapolated benefit of avoiding symptomatic local disease progression). 25% pT0 response was seen; gene expression profiles of these patients should be sought. Despite a small sample, our analysis lends insight and support to the feasibility of the SWOG 1802 RP arm. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1195-e1196 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ramkishen Narayanan More articles by this author Jennifer Linehan More articles by this author Nicholas Vogelzang More articles by this author Chikako Matsuba More articles by this author Przemyslaw Twardowski More articles by this author Timothy Wilson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...