Improved Survival With Prostate Radiation in Addition to Androgen Deprivation Therapy for Men With Newly Diagnosed Metastatic Prostate Cancer

Rusthoven, Chad G.; Jones, Bernard L.; Flaig, Thomas W.; Crawford, E. David; Koshy, Matthew; Sher, David J.; Mahmood, Usama; Chen, Ronald C.; Chapin, Brian F.; Kavanagh, Brian D.; Pugh, Thomas J.

doi:10.1200/jco.2016.67.4788

Cited by 224 publications

(147 citation statements)

References 33 publications

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“…Although exact definitions of oligometastatic are variable, it conceptually represents an intermediate step between localized disease and widespread metastases . It is hypothesized that these patients with oligometastatic disease may benefit from local therapy . It is further hypothesized that eradication of all sites of oligometastatic disease could result in clinical benefits .…”

Section: Areas For Further Researchmentioning

confidence: 99%

Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Buyyounouski

Choyke

McKenney

et al. 2017

CA A Cancer J Clinicians

284

191

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Answer questions and earn CME/CNE The eighth edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) Staging Manual has been updated and improved to ensure the highest degree of clinical relevance and to improve its utility for patient evaluation and clinical research. Major changes include: 1) pathologically organ-confined disease is now considered pT2 and is no longer subclassified by extent of involvement or laterality, 2) tumor grading now includes both the Gleason score (as in the seventh edition criteria) and the grade group (introduced in the eighth edition criteria), 3) prognostic stage group III includes select, organ-confined disease based on prostate-specific antigen and Gleason/grade group status, and 4) 2 statistical prediction models are included in the staging manual. The AJCC will continue to critically analyze emerging prostate cancer biomarkers and tools for their ability to prognosticate and guide treatment decision making with the highest level of accuracy and confidence for patients and physicians. CA Cancer J Clin 2017;67:245-253. © 2017 American Cancer Society.

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Section: Areas For Further Researchmentioning

confidence: 99%

Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Buyyounouski

Choyke

McKenney

et al. 2017

CA A Cancer J Clinicians

284

191

View full text Add to dashboard Cite

show abstract

“…23 Men with N1 disease treated with RP have a reduced risk of death from prostate cancer compared to those treated with non-curative therapies. 24,25 A reduction in prostate cancer-specific mortality in men with M1 disease whose primary tumor is treated definitively has also been shown in population-based studies, 26–28 and the feasibility of RP in this population has been established. 29,30 Prospective trials to test this question are combining surgery or radiation with “best systemic therapy” (NCT01751438) or radiation to the primary tumor with systemic therapy (NCT00268476, NCT01957436, and NTR271).…”

Section: Discussionmentioning

confidence: 87%

A Pilot Study of a Multimodal Treatment Paradigm to Accelerate Drug Evaluations in Early-stage Metastatic Prostate Cancer

O’Shaughnessy

McBride

Vargas

et al. 2017

Urology

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OBJECTIVE To evaluate a multimodal strategy aimed at treating all sites of disease that provides a rapid readout of success or failure in men presenting with non-castrate metastatic prostate cancers that are incurable with single modality therapy. MATERIALS AND METHODS Twenty selected men with oligometastatic M1a (extrapelvic nodal disease) or M1b (bone disease) at diagnosis were treated using a multimodal approach that included androgen deprivation, radical prostatectomy plus pelvic lymphadenectomy (retroperitoneal lymphadenectomy in the presence of clinically positive retroperitoneal nodes), and stereotactic body radiotherapy to osseous disease or the primary site. Outcomes of each treatment were assessed sequentially. Androgen deprivation was discontinued in responding patients. The primary end point was an undetectable prostate-specific antigen (PSA) after testosterone recovery. The goal was to eliminate all detectable disease. RESULTS Each treatment modality contributed to the outcome: 95% of the cohort achieved an undetectable PSA with multimodal treatment, including 25% of patients after androgen deprivation alone and an additional 50% and 20% after surgery and radiotherapy, respectively. Overall, 20% of patients (95% confidence interval: 3%–38%) achieved the primary end point, which persisted for 5, 6, 27+, and 46+ months. All patients meeting the primary end point had been classified with M1b disease at presentation. CONCLUSION A sequentially applied multimodal treatment strategy can eliminate detectable disease in selected patients with metastatic spread at diagnosis. The end point of undetectable PSA after testosterone recovery should be considered when evaluating new approaches to rapidly set priorities for large-scale testing in early metastatic disease states and to shift the paradigm from palliation to cure.

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“…11 The authors showed an overall survival benefit through the addition of RT to ADT for these patients on both univariable and multivariable analysis (HR 0.62, 95% CI 0.55-0.71, P < 0.001) adjusted for age, year, race, comorbidity score, bPSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility and insurance status. 11 Subgroup analyses from that study showed a greater benefit with prostate RT among patients with Gleason scores ≤8 and T1-3 (vs T4) tumors. 11 Subgroup analyses from that study showed a greater benefit with prostate RT among patients with Gleason scores ≤8 and T1-3 (vs T4) tumors.…”

Section: Studies Reporting Oncological Outcomesmentioning

confidence: 92%

Local treatment for metastatic prostate cancer: A systematic review

et al. 2018

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The potential oncological benefit for radical treatment in the setting of oligometastatic prostate cancer has been under investigation and is frequently discussed. We carried out a systematic review of English language articles using the Medline database (January 2000 to May 2017) to identify studies reporting local treatment in men with metastatic prostate cancer at diagnosis. Primary end-points were oncological outcomes, such as cancer-specific and overall mortality. Secondary end-points were non-oncological outcomes, such as complications, operating room time, blood loss or length of hospital stay. Two independent authors reviewed and extracted all search results. Overall, 18 studies reporting on local treatment in metastatic prostate cancer patients were identified (14 original articles, three brief correspondences and one letter to the editor). All of them were retrospective; one partly included prospective data. All studies addressed oncological outcomes, 16 compared local treatment with no-local treatment and 14 adjusted for confounders using multivariable regression models. All but one study concluded a survival benefit for local treatment in the metastatic setting. Due to heterogeneity of available data, a representative meta-analysis could not be carried out. Five studies reported non-oncological outcomes. Although local treatment in metastatic prostate cancer appears to be feasible, its oncological effect remains unclear due to high susceptibility of available studies to significant selection bias.

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Improved Survival With Prostate Radiation in Addition to Androgen Deprivation Therapy for Men With Newly Diagnosed Metastatic Prostate Cancer

Abstract: In this large contemporary analysis, men with mPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted.

Cited by 224 publications

References 33 publications

Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

A Pilot Study of a Multimodal Treatment Paradigm to Accelerate Drug Evaluations in Early-stage Metastatic Prostate Cancer

Local treatment for metastatic prostate cancer: A systematic review

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