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Cytoreductive radical prostatectomy for prostate cancer with minimal osseous metastases: Results of a first feasibility and case control study

Urologe A. 2014 Dec 19. [Epub ahead of print]

Urologe A. 2014 Dec 19. [Epub ahead of print]

Abstract

BACKGROUND:

Androgen deprivation therapy (ADT) represents the standard treatment for patients with prostate cancer (PCA) and osseous metastases. We explored the role of cytoreductive radical prostatectomy in PCA with low volume skeletal metastases in terms of a feasibility study.

MATERIAL AND METHODS:

A total of 23 patients with biopsy proven PCA, minimal osseous metastases (≤3 hot spots on bone scan), absence of visceral or extensive lymph node metastases and a decrease in prostate-specific antigen (PSA) to <1.0 ng/ml after neoadjuvant ADT were included in the feasibility study (group A). The control group (group B) consisted of 38 men with metastatic PCA who were treated by ADT alone. Surgery-related complications, time to castration resistance, symptom-free, cancer-specific and overall survival were analyzed using descriptive statistical analyses.

RESULTS:

The mean age was 61 years (range 42-69 years) and 64 years (47-83) in groups A and B, respectively, with similar patient characteristics in terms of initial PSA level, biopsy Gleason score, clinical stage and extent of metastatic disease. The median follow-up was 34.5 months (7-75 months) and 47 months (28-96 months) in groups A and B, respectively. Median time to castration resistance was 40 months (9-65 months) and 29 months (16-59 months) in groups A and B, respectively (p=0.04). Patients in group A experienced significantly better clinical symptom-free (38.6 versus 26.5 months, p=0.032) and cancer-specific survival rates (95.6% versus 84.2%, p=0.043) whereas the overall survival was similar. In group A none of the men underwent palliative surgical procedures for locally progressing PCA compared to 29% in group B.

CONCLUSIONS:

Cytoreductive radical prostatectomy is feasible in well-selected men with metastatic PCA who responded well to neoadjuvant ADT. These men have a long life expectancy and the risk of locally recurrent PCA and local complications are reduced. Cytoreductive radical prostatectomy might be a treatment option in the multimodal management of PCA with minimal osseous metastases.

Comment from Henk van der Poel: In 23 men with less than 4 bone metastases, prostatectomy after a good response to neoadjuvant androgen ablation resulted in a longer interval to CRPC development, (40m versus 29m) in comparison to a selected control group only treated with androgen ablation. Overall survival of both groups was similar but local problems seemed less in the prostatectomy group. Functional QOL data were not extensively reported but these data hold promise and warrant a randomized trial.

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