In their institution, Dr. Stief notes that they have performed 85 radical prostatectomies for patients with bone metastasis since 2011. The median age of these patients was 66 years (range 46-80 years), median PSA was 56 ng/mL without hormonal therapy and 13.4 ng/mL for patients on ADT. Among these patients, 27 had oligometastases and 58 patients had polymetastases. The median surgical time for radical prostatectomy was 84.2 minutes (range 54-221), the transfusion rate was 4.7%, median catheter time was 8.7 days (range 6-30 days), and bladder neck contracture rate was 24.7%. There were 20 patients with pathologic Gleason 8 disease, 47 with Gleason 9, and 11 with Gleason 10. There were a median 13.5 lymph nodes removed with lymph node positivity in 60% of the patients (mean 13 lymph nodes removed for those pN+; mean 11 lymph nodes removed for pN0). Over a median follow-up of 19 months, 55% of patients were without pads, 21% used one pad per day, 9% used two pads/day and 14% used >2 pads/day. Four patients were dead of disease, all patients that had polymetastases at the time of radical prostatectomy. One patient had pathologic pN+ disease, one had pathologic Gleason 9 and three were Gleason 10. As part of evolving standard of care, three patients received radiation to the bone metastases and several received Radium-223.
Dr. Stief concluded with several take home points:
- Small volume cancers may seed bone metastases
- Bone metastases occur in the absence of lymph node metastases
- Aggressive multimodal approaches for aggressive prostate cancers may yield a survival benefit, but the jury is still out
Presented by: Christian Stief, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark