Cargando…

Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy

Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables suc...

Descripción completa

Detalles Bibliográficos
Autores principales: Devos, Gaëtan, Berghen, Charlien, Van Eecke, Henri, Stichele, Arthur Vander, Van Poppel, Hendrik, Goffin, Karolien, Mai, Cindy, De Wever, Liesbeth, Albersen, Maarten, Everaerts, Wouter, De Meerleer, Gert, Joniau, Steven
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464259/
https://www.ncbi.nlm.nih.gov/pubmed/32823690
http://dx.doi.org/10.3390/cancers12082271
_version_ 1783577323428118528
author Devos, Gaëtan
Berghen, Charlien
Van Eecke, Henri
Stichele, Arthur Vander
Van Poppel, Hendrik
Goffin, Karolien
Mai, Cindy
De Wever, Liesbeth
Albersen, Maarten
Everaerts, Wouter
De Meerleer, Gert
Joniau, Steven
author_facet Devos, Gaëtan
Berghen, Charlien
Van Eecke, Henri
Stichele, Arthur Vander
Van Poppel, Hendrik
Goffin, Karolien
Mai, Cindy
De Wever, Liesbeth
Albersen, Maarten
Everaerts, Wouter
De Meerleer, Gert
Joniau, Steven
author_sort Devos, Gaëtan
collection PubMed
description Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan–Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27–70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58–164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103–132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials.
format Online
Article
Text
id pubmed-7464259
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-74642592020-09-04 Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy Devos, Gaëtan Berghen, Charlien Van Eecke, Henri Stichele, Arthur Vander Van Poppel, Hendrik Goffin, Karolien Mai, Cindy De Wever, Liesbeth Albersen, Maarten Everaerts, Wouter De Meerleer, Gert Joniau, Steven Cancers (Basel) Article Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan–Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27–70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58–164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103–132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials. MDPI 2020-08-13 /pmc/articles/PMC7464259/ /pubmed/32823690 http://dx.doi.org/10.3390/cancers12082271 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Devos, Gaëtan
Berghen, Charlien
Van Eecke, Henri
Stichele, Arthur Vander
Van Poppel, Hendrik
Goffin, Karolien
Mai, Cindy
De Wever, Liesbeth
Albersen, Maarten
Everaerts, Wouter
De Meerleer, Gert
Joniau, Steven
Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy
title Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy
title_full Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy
title_fullStr Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy
title_full_unstemmed Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy
title_short Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy
title_sort oncological outcomes of metastasis-directed therapy in oligorecurrent prostate cancer patients following radical prostatectomy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464259/
https://www.ncbi.nlm.nih.gov/pubmed/32823690
http://dx.doi.org/10.3390/cancers12082271
work_keys_str_mv AT devosgaetan oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT berghencharlien oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT vaneeckehenri oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT stichelearthurvander oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT vanpoppelhendrik oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT goffinkarolien oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT maicindy oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT deweverliesbeth oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT albersenmaarten oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT everaertswouter oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT demeerleergert oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy
AT joniausteven oncologicaloutcomesofmetastasisdirectedtherapyinoligorecurrentprostatecancerpatientsfollowingradicalprostatectomy