Introduction: 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