Cytoreductive radical prostatectomy (cRP) following neoadjuvant androgen-deprivation therapy for men with hormone-naïve low-volume metastatic prostate cancer (mhnPCA) has long-term survival and other benefits, according to study findings presented as part of the American Urological Association 2020 Virtual Experience.

The finding is from a study that included 32 patients with mhnPCA who underwent cRP following 6 months of neoadjuvant androgen-deprivation therapy (ADT) and 38 case-matched patients with mhnPCA who received only 6 months of neoadjuvant ADT. All men had low-volume skeletal metastases (3 lesions or fewer on bone scans) with no visceral or retroperitoneal lymph node metastases, and a PSA decrease of less than 1.0 ng/mL following 6 months of ADT.

After a median follow-up of 75.5 months, 27 patients (84.4%) were alive, Patricia John, MD, and colleagues at the University of Cologne in Köln, Germany, reported in a study abstract. Of these, 16 (59.2%) progressed to metastatic castration-resistant prostate cancer. The median overall survival (OS) time was 78.9 months, and the median time to castration-resistant disease was 40 months.

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OS, progression-free survival, and time to castration-resistant disease were significantly greater in the cRP group than the ADT monotherapy arm. Locally symptomatic relapses occurred in none of the cRP recipients compared with 12 patients (31.6%) of the ADT-only arm.

“Although data from prospective randomized trials are lacking, cRP should be considered as a valid treatment option in well selected patients with low volume metastatic disease and good response to neoadjuvant ADT,” the investigators concluded.

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John P, Pfister D, Heidenreich A, Hartmann F. Long-term results of cytoreductive radical prostatectomy in men hormone-naive, low volume metastatic prostate cancer (MHNPCA). Presented at the American Urological Association 2020 Virtual Experience held in May. Abstract MP79-16.