The Role of Cytoreductive Radical Prostatectomy in the Treatment of Newly Diagnosed Low-volume Metastatic Prostate Cancer. Results from the Local Treatment of Metastatic Prostate Cancer (LoMP) Registry

Abstract

Background Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, newly diagnosed metastatic prostate cancer (ndmPC). Objective to evaluate whether cytoreductive radical prostatectomy (cRP) is equally beneficial as RTp in low-volume ndmPC. Design, setting, and participants A multicenter prospective registry was established in 2014 to observe patients with ndmPC. Eligible patients were offered cRP or RTp. For this study we selected only patients with low-volume ndmPC ( n = 109). Of these, 48, 26, and 35 patients underwent cRP, RTp, and no local therapy (NLT), respectively. Median follow-up was 32 mo (interquartile range 16–49). Intervention cRP was compared with RTp and NLT. Outcome measurements and statistical analysis Overall survival (OS), cancer-specific survival (CSS), and local event–free survival (LEFS) were calculated using the Kaplan-Meier method. Factors prognostic for OS were identified using univariate and multivariate Cox regression analysis. Results and limitations The 2-yr OS was 93%, 100%, and 69%, and 2-yr CSS was 93%, 100%, and 75% for cRP, RTp, and NLT, respectively. The cRP and RTp groups had better OS compared to NLT and there was no significant difference between cRP and RTp. The 2-yr LEFS was 92%, 77%, and 60% for cRP, RTp, and NLT, respectively. The cRP group had better LEFS compared to RTp and NLT, and there was no significant difference between RTp and NLT. Advanced tumor stage, Eastern Cooperative Oncology Group performance status ≥2, and NLT were negative prognostic factors for OS. The main limitation is selection of fitter patients with less advanced tumors for cRP and the small sample size. Conclusions For selected patients with low-volume ndmPC, cRP is able to achieve similar OS and CSS to RTp. cRP is effective in preventing local events due to disease progression. Patient summary Patients with a low volume of newly diagnosed prostate cancer that has spread beyond the prostate gland might benefit from removal of the prostate, which we found was as effective as radiotherapy to the prostate in prolonging survival. Removal of the prostate is effective in preventing urinary problems caused by cancer progression.

Radical Prostatectomy or Radiotherapy in Oligometastatic Prostate Cancer: Is It Nearly Time To Call It a Draw?

“…In addition, a recently published prospective registry study, the Belgian LoMP trial, confirmed the equivalent efficacy of surgery and RT in omHSPC [9]. In this comparative study of 109 men treated with surgery, RT, or no local treatment, the locally treated group had a survival advantage over no local treatment.…”

Cytoreductive radical prostatectomy or radiation therapy for metastases prostate cancer: Evidence from meta-analysis

“…3 B). Three studies assessed the OS of oligometastatic PCa, [ 7 , 12 , 13 ] and pooled data showed cytoreductive surgery did not significantly affect the OS (OR = 1.33, 95% CI 0.87–2.02, P = .19, Fig. 4 ).…”

Clinical Significance of Mesenchymal Circulating Tumor Cells in Patients With Oligometastatic Hormone-Sensitive Prostate Cancer Who Underwent Cytoreductive Radical Prostatectomy

“…A phase 3 trial found that prostate-directed radiation can improve survival outcomes in patients with a low metastatic burden ( 26 ). Despite no hard evidence for the survival benefit of CRP in oligometastatic prostate cancer, several retrospective and prospective studies have suggested that CRP reduces the risk of clinical progression and improves long-term survival in patients with oligometastatic prostate cancer ( 3 – 6 , 13 ). Currently, PSA kinetics are commonly used to follow disease progression, but they cannot be utilized to predict the prognosis of omHSPC patients well because of inherent limitations ( 24 ).…”

“…Retrospective studies have reported that cytoreductive radical prostatectomy (CRP) reduces the risk of clinical progression and improves cancer-specific survival (CSS) ( 3 – 5 ). According to a recent prospective registry, CRP is able to improve CSS and overall survival (OS) in newly diagnosed low-volume metastatic prostate cancer patients ( 6 ). Despite improvements in diagnosis and treatment, omHSPC patients comprise a heterogeneous population of men with different outcomes who will ultimately develop castration-resistant cancer ( 7 , 8 ).…”