PURPOSE: Androgen deprivation (ADT) represents the standard treatment for PCA with osseous metastases.
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We explored the role of cytoreductive radical prostatectomy in PCA with low volume skeletal metastases in terms of a feasibility study.
MATERIAL AND METHODS: 23 patients with biopsy proven PCA, minimal osseous metastases (≤ 3 hot spots on bone scan), absence of visceral or extensive lymph node metastases and PSA decrease to < 1.0 ng/ml after neoadjuvant ADT were included in the feasibility study. 38 men with metastatic PCA who were treated by ADT without local therapy served as control group (group B). Surgery-related complications, time to castration resiatence, symptomatic-free, cancer-specific and overall survival were analyzed using descriptive statistical analysis.
RESULTS: Mean age was 61 (42-69) and 64 (47-83) years in group A and B, respectively, with similar patient characteristics in terms of initial PSA, biopsy Gleason score, clinical stage, extent of metastatic disease. The median follow-up was 34.5 (7-75) and 47 (28-96) months in group A and B, respectively. Median time to CRPC was 40 (9-65) and 29 (16-59) months in groups A and B, respectively (p=0.04)- Patients in group A experienced significantly better clinical PFS (38.6 versus 26.5 months, p=0.032) and cancer specific survival rate (95.6% versus 84.2%, p=0.043) whereas the overall survival was similar. 0% and 29% of men in group A and B, respectively, underwent palliative surgical procedures for locally progressing PCA.
CONCLUSIONS: CRP is feasible in well selected men with metastatic PCA who respond well to neoadjuvant ADT. These men have a long life expectancy and CRP reduces the risk of locally recurrent PCA and local complications. CRP might be a treatment option in the multimodality management of PCA with minimal osseous metastases.
Heidenreich A, Pfister D, Porres D. Are you the author?
Department of Urology, Uniklinik RWTH Aachen, Germany.
Reference: J Urol. 2014 Sep 21. pii: S0022-5347(14)04486-3.