To explore the role of cytoreductive radical prostatectomy (CRP) for locally resectable and distant oligometastatic prostate cancer (PCa).
Oligometastases was defined as the presence of five or fewer metastatic lesions detected on 99mTc bone scan and no suspicious visceral involvement at pretreatment imaging. Clinical data on 111 consecutive patients who were diagnosed as oligometastatic PCa in our center from 2005 to 2016 was retrospectively collected. In this retrospective cohort study, 35 patients underwent CRP and androgen deprivation therapy (ADT), and 76 patients underwent ADT alone. Oncological outcomes were analyzed by employing Kaplan-Meier method.
The median follow-up of both groups was 35 months. In whole cohort analyses, prostate specific antigen (PSA) decrease velocity (p=0.167), PSA half-time (p=0.263), and PSA nadir (p=0.196) were not significantly different between two groups. Meanwhile, the differences in oncological outcomes between two groups did not reach statistical significance with regard to PSA relapse-free survival (PRFS, p=0.184), clinical progression free survival (CPFS, p=0.118), and cancer specific survival (CSS) (p=0.773). In addition, similar results were also observed in prespecified subgroup analyses (lower PSA group [0∼100 ng/ml, p=0.543], lower Gleason score group [6∼7, p=0.266], lower clinical T stage group [2∼3 stage, p=0.962], lower radiological N stage group [0 stage, p=0.364]).
In our study, significant benefit from CRP has not been detected in patients with oligometastatic PCa. Facing current trend, it demands deliberate consideration to select candidates for cytoreductive surgery, and the selection criteria should be further refined by incorporating additional prognostic factors.
Urology. 2019 Jun 07 [Epub ahead of print]
Tian Lan, Ye Chen, QinJun Su, JianJun Ye
Department of Urology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China., Department of Surgery and Anesthesiology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China. Electronic address: ., Department of Pathology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China., China Department of Medical Imaging, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China.