Local treatment for metastatic prostate cancer: A systematic review

Abstract

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.

Re: Local treatment for metastatic prostate cancer: A systematic review

“…Dear Editor, Inoue et al reported an increased risk of secondary hematological neoplasms in patients with metastatic germ cell tumor receiving multiple regimens of chemotherapy. 1 Our group has already reported on the incidence of secondary hematological neoplasms in Japanese patients with germ cell tumor receiving chemotherapy. 2 In our series of 139 patients, three patients (2.2%) developed acute myeloid leukemia or myelodysplastic syndrome, of whom all had received a single first-line regimen of conventional chemotherapy.…”

“…3 That study showed an overall survival benefit (hazard ratio 0.327 vs control) when RT was added to prostate treatment, which is in accordance with previous reports. 1 Similarly, in propensity score-matched analysis, there was a statistically significant difference in overall survival between patients treated with ADT and ADT plus RT.…”

“…1 The patients in whom local treatment with ADT is beneficial, when to provide local treatment for these patients and which local treatment modality is optimal remain to be elucidated. The results of several ongoing prospective studies should confirm the possible clinical benefit of adding local definitive treatment to ADT.…”

“…We read with interest the published article by Tilki et al, which was a systematic review of local treatments for metastatic prostate cancer (mPCa). 1 Recently, there has been growing interest in the possible prognostic impact of adding definitive local treatment to systemic therapy. Although the effectiveness of androgen deprivation therapy (ADT) plus radiotherapy (RT) and its association with improved survival are promising for lymph node-positive prostate cancer, limited retrospective data exist regarding the additive role of RT to the prostate to treat mPCa.…”

“…The results of several ongoing prospective studies should confirm the possible clinical benefit of adding local definitive treatment to ADT. 1 The patients in whom local treatment with ADT is beneficial, when to provide local treatment for these patients and which local treatment modality is optimal remain to be elucidated. Post-hoc/ subgroup analyses of prospective randomized controlled studies might answer these questions in the near future.…”