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- Title:
Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer.
- Document type:
- Journal Article
- Author(s):
- Babst, Christa; Amiel, Thomas; Maurer, Tobias; Knipper, Sophie; Lunger, Lukas; Tauber, Robert; Retz, Margitta; Herkommer, Kathleen; Eiber, Matthias; von Amsberg, Gunhild; Graefen, Markus; Gschwend, Juergen; Steuber, Thomas; Heck, Matthias
- Abstract:
- OBJECTIVE: Cytoreductive radical prostatectomy (cRP) has been proposed as local treatment option in metastatic hormone-sensitive prostate cancer (mHSPC) to prevent local complications and potentially improve oncological outcomes. In this study, we examined the feasibility of a multimodal concept with primary chemohormonal therapy followed by cRP and analyzed prostate size reduction under systemic treatment, postoperative complication rates, as well as early postoperative continence. METHODS: In this retrospective study, 38 patients with mHSPC underwent cRP after primary chemohormonal therapy (3-monthly luteinising hormone-releasing hormone-analogue + six cycles 3-weekly docetaxel 75 mg/m2) at two centers between September 2015 and December 2018. RESULTS: Overall, 10 (26%) patients had high volume and 28 (74%) patients had low volume disease at diagnosis, according to CHAARTED definition. Median prostate-specific antigen (PSA) decreased from 65 ng/mL (interquartile range [IQR] 35.0-124.5 ng/mL) pre-chemotherapy to 1 ng/mL (IQR 0.3-1.7 ng/mL) post-chemotherapy. Prostate gland volume was significantly reduced by a median of 50% (IQR 29%-56%) under chemohormonal therapy (p = 0.003). Postoperative histopathology showed seminal vesicle invasion in 33 (87%) patients and negative surgical margins in 17 (45%) patients. Severe complications (Grade 3 according to Clavien-Dindo) were observed in 4 (11%) patients within 30 days. Continence was reached in 87% of patients after 1 month and in 92% of patients after 6 months. Median time to castration-resistance from begin of chemohormonal therapy was 41.1 months and from cRP was 35.9 months. Postoperative PSA-nadir ≤1 ng/mL versus >1 ng/mL was a significant predictor of time to castration-resistance after cRP (median not reached versus 5.3 months; p<0.0001). CONCLUSION: We observed a reduction of prostate volume under chemohormonal therapy going along with a low postoperative complication and high early continence rate. However, the oncologic benefit from cRP is still under evaluation.
- Journal title abbreviation:
- Asian J Urol
- Year:
- 2022
- Journal volume:
- 9
- Journal issue:
- 1
- Pages contribution:
- 69-74
- Fulltext / DOI:
- doi:10.1016/j.ajur.2021.04.003
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/35198399
- Print-ISSN:
- 2214-3882
- TUM Institution:
- Klinik und Poliklinik für Nuklearmedizin; Klinik und Poliklinik für Urologie
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