Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, newly diagnosed metastatic prostate cancer (ndmPC).
to evaluate whether cytoreductive radical prostatectomy (cRP) is equally beneficial as RTp in low-volume ndmPC.
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).
cRP was compared with RTp and NLT.
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.
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.
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.
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.
European urology open science. 2021 Jun 05*** epublish ***
Nicolaas Lumen, Elise De Bleser, Sarah Buelens, Wesley Verla, Filip Poelaert, Wietse Claeys, Valérie Fonteyne, Sofie Verbeke, Geert Villeirs, Kathia De Man, Sylvie Rottey, Charles Van Praet, Karel Decaestecker, Piet Ost, LoMP Registry Investigators
Department of Urology, Ghent University Hospital, Ghent, Belgium., Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium., Department of Pathology, Ghent University Hospital, Ghent, Belgium., Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium., Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.