To investigate the role of cytoreductive radical prostatectomy in addition to the standard of care for patients with newly diagnosed metastatic prostate cancer.
This multicentric, prospective study included asymptomatic patients from 2014-2018 (NCT02138721). Radical prostatectomy was offered to all fit patients with resectable tumors, resulting in 40 patients. Standard of care was administered to 40 patients who were ineligible or unwilling to undergo surgery. Primary endpoint was castration-resistant prostate cancer-free survival at time of ≥50% events. Secondary endpoint was local event-free survival. Kaplan-Meier and Cox regression analyses with propensity score analysis were applied.
After a median follow-up of 35 months (quartiles: 24-47), 42 patients became castration resistant or died. Median castration-resistant prostate cancer-free survival was 53 (95%CI: 14-92) vs 21 months (95%CI: 15-27) for radical prostatectomy compared to standard of care (p=0.017). Three-year estimates for local event-free survival were 83% (95%CI: 71-95) vs 59% (95%CI: 51-67) for radical prostatectomy compared to standard of care (p=0.012). However, treatment group showed no significance in the multivariable models for castration-resistant prostate cancer-free (p=0.5) and local event-free survival (p=0.3) adjusted for propensity score analysis. Complications were comparable to the non-metastatic setting. Patients undergoing surgery were younger with lower baseline PSA, alkaline phosphatase and metastatic burden.
The LoMP study was unable to show a difference between both inclusion groups regarding castration-resistant prostate cancer-free survival for asymptomatic patients with newly diagnosed metastatic prostate cancer. These results validate previous evidence that, in well-selected and informed patients, radical prostatectomy is feasible and safe with corresponding continence rates compared to the non-metastatic, high risk setting. Whether radical prostatectomy could be a valuable option to achieve good local palliation, needs to be further researched. Overall, the role of radical prostatectomy needs to be further explored in randomized studies to correct for potential bias.
BJU international. 2021 Jul 21 [Epub ahead of print]
Sarah Buelens, Filip Poelaert, Tom Claeys, Elise De Bleser, Bert Dhondt, Wesley Verla, Piet Ost, Bernard Rappe, Bart De Troyer, Caroline Verbaeys, Bart Kimpe, Ignace Billiet, Hendrik Plancke, Karen Fransis, Patrick Willemen, Filip Ameye, Karel Decaestecker, Nicolaas Lumen
Dept. of Urology, Ghent University Hospital, Ghent, Belgium., Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium., Dept. of Urology, ASZ, Aalst, Belgium., Dept. of Urology, AZ Nikolaas, Sint-Niklaas, Belgium., Dept. of Urology, AZ Jan Palfijn, Ghent, Belgium., Dept. of Urology, Sint-Lucas Hospital, Bruges, Belgium., Dept. of Urology, AZ Groeninge, Kortrijk, Belgium., Dept. of Urology, Imelda Hospital, Bonheiden, Belgium., Dept. of Urology, University Hospital Antwerp, Antwerp, Belgium., Dept. of Urology, Jessa Hospital, Ghent, Belgium., Dept. of Urology, AZ Maria Middelares, Ghent, Belgium.