TY - JOUR
T1 - Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer
AU - Babst, Christa
AU - Amiel, Thomas
AU - Maurer, Tobias
AU - Knipper, Sophie
AU - Lunger, Lukas
AU - Tauber, Robert
AU - Retz, Margitta
AU - Herkommer, Kathleen
AU - Eiber, Matthias
AU - von Amsberg, Gunhild
AU - Graefen, Markus
AU - Gschwend, Juergen
AU - Steuber, Thomas
AU - Heck, Matthias
N1 - Publisher Copyright:
© 2022 Editorial Office of Asian Journal of Urology
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
KW - Chemohormonal therapy
KW - Continence rate
KW - Cytoreductive radical prostatectomy
KW - Feasibility
KW - Metastatic hormone-sensitive prostate cancer
KW - Prevent local complications
UR - http://www.scopus.com/inward/record.url?scp=85111475413&partnerID=8YFLogxK
U2 - 10.1016/j.ajur.2021.04.003
DO - 10.1016/j.ajur.2021.04.003
M3 - Article
AN - SCOPUS:85111475413
SN - 2214-3882
VL - 9
SP - 69
EP - 74
JO - Asian Journal of Urology
JF - Asian Journal of Urology
IS - 1
ER -
