Multicentre, prospective study on local treatment of metastatic prostate cancer (LoMP study)

Abstract

To investigate the role of cytoreductive radical prostatectomy in addition to standard of care for patients with newly diagnosed metastatic prostate cancer. Materials and MethodsThis multicentre, prospective study included asymptomatic patients from 2014 to 2018 (NCT02138721). Cytoreductive radical prostatectomy was offered to all fit patients with resectable tumours, resulting in 40 patients. Standard of care was administered to 40 patients who were ineligible or unwilling to undergo surgery. The primary endpoint was castration resistant cancer-free survival at the time point of ≥50% events. The secondary endpoint was local event-free survival. Kaplan-Meier and Cox regression analyses with propensity-score analysis were applied. ResultsAfter a median (quartiles) follow-up of 35 (24-47) months, 42 patients became castration-resistant or died. The median castration resistant cancer-free survival was 53 (95% confidence interval [CI] 14-92) vs 21 (95% CI 15-27) months for cytoreductive radical prostatectomy compared to standard of care (P = 0.017). The 3-year estimates for local event-free survival were 83% (95% CI 71-95) vs 59% (95% CI 51-67) for cytoreductive radical prostatectomy compared to standard of care (P = 0.012). However, treatment group showed no significance in the multivariable models for castration resistant cancer-free survival (P = 0.5) or local event-free survival (P = 0.3), adjusted for propensity-score analysis. Complications were similar to the non-metastatic setting. Patients undergoing surgery were younger, with lower baseline prostate-specific antigen levels, alkaline phosphatase levels and metastatic burden. ConclusionThe present LoMP study was unable to show a difference between the two inclusion groups regarding castration resistant cancer-free survival for asymptomatic patients with newly diagnosed metastatic prostate cancer. These results validate previous evidence that, in well-selected and informed patients, cytoreductive radical prostatectomy is feasible and safe, with corresponding continence rates compared to the non-metastatic, high-risk setting. Whether cytoreductive radical prostatectomy could be a valuable option to achieve good local palliation needs to be further researched. Overall, the role of cytoreductive radical prostatectomy needs to be further explored in randomized studies to correct for potential bias.

A nomogram model for determining optimal patients for local therapy in metastatic prostate cancer: a SEER database-based study

“…In other words, local therapy can allow patients to maintain their original quality of life while controlling tumor progression. Two recent prospective studies have also validated this point, Sarah Buelens [ 16 ] and Chris C Parker et al [ 17 ] suggest that LT can improve long-term survival in patients with mPca without reducing the quality of life.…”

The current role of precision surgery in oligometastatic prostate cancer

“…However, CRP was not associated with improved CRPC-free survival on multivariable Cox regression analyses. 70 Despite its prospective setting, this study was limited by a selection bias and misbalance in metastatic burden; 43% of the entire cohort had high-volume disease with a significant misbalance toward the SOC group (20% versus 65%). 70 …”

“… 56 Similarly, a study derived from the prospective Local Treatment of Metastatic Prostate Cancer (LoMP) registry included 40 men who underwent CRP with extended PLND and 40 men who received SOC for de novo mHSPC. 70 The metastatic volume was classified according to the CHAARTED definition, and CRP was offered if patients were fit to undergo CRP and PCa was considered resectable (<T4). 70 Median CRPC-free survival was 53 months in the CRP arm compared to 21 months in the control arm.…”

“… 70 The metastatic volume was classified according to the CHAARTED definition, and CRP was offered if patients were fit to undergo CRP and PCa was considered resectable (<T4). 70 Median CRPC-free survival was 53 months in the CRP arm compared to 21 months in the control arm. However, CRP was not associated with improved CRPC-free survival on multivariable Cox regression analyses.…”

Oligometastatic Disease in Prostate Cancer. Evolving paradigm: current knowledge, diagnostic techniques and treatment strategies

“…Adverse events were within acceptable limits and contributed to reducing local symptoms, and LC was effective. However, to draw reliable conclusions, we must await the results of future prospective studies, including the TRoMbone study [ISRCTN15704862], studies on RP in OMPCa with bone oligometastases [35], [36], [NCT02454543],…”