De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown.
To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET.
Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET.
Cytoreductive radical prostatectomy.
Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed.
Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up.
Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy.
We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.
European urology oncology. 2023 Oct 14 [Epub ahead of print]
Pawel Rajwa, Daniele Robesti, Michael Chaloupka, Fabio Zattoni, Alexander Giesen, Nicolai A Huebner, Aleksandra Krzywon, Marcin Miszczyk, Matthias Moll, Rafał Stando, Edoardo Cisero, Sofiya Semko, Enrico Checcucci, Gaëtan Devos, Maria Apfelbeck, Cecilia Gatti, Giancarlo Marra, Roderick C N van den Bergh, Gregor Goldner, Sazan Rasul, Francesco Ceci, Fabrizio Dal Moro, Francesco Porpiglia, Paolo Gontero, Anders Bjartell, Christian Stief, Axel Heidenreich, Steven Joniau, Alberto Briganti, Shahrokh F Shariat, Giorgio Gandaglia, EAU-Young Academic Urologists (YAU) Prostate Cancer Working Party
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland., Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, LMU Klinikum, Ludwig-Maximilians University Munich, Munich, Germany., Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland., IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland., Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Radiotherapy, Holy Cross Cancer Center, Kielce, Poland., Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Italy., Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany., Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy., Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy., Department of Urology, St Antonius Hospital, Utrecht, The Netherlands., Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria., Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Skåne University Hospital, Lund University, Malmö, Sweden., Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA. Electronic address: .