Adding Androgen Deprivation Therapy to MDT Beneficial in Oligometastatic CSPC

Metastasis-directed therapy (MDT) in combination with androgen deprivation therapy (ADT) was associated with greater freedom from biochemical progression compared with MDT alone in a multi-institutional study of men with oligometastatic castration-sensitive prostate cancer (CSPC), investigators reported at the American Urological Association’s 2023 Annual Meeting in Chicago.

Matthew P. Deek, MD, of Rutgers Cancer Institute of New Jersey in New Brunswick, and colleagues studied 263 patients who underwent MDT for oligometastatic (less than 5 lesions) CSPC: 105 with and 158 without ADT. The median length of ADT use was 21.3 months. The ADT and no-ADT groups had a median follow-up of 49.5 months and 54.5 months, respectively. The investigators defined biochemical progression as a PSA nadir plus 2 ng/dL for patients treated with radiation or an increase above 0.2 ng/dL for those who underwent surgery.

ADT use was significantly associated with an improved 5-year rate of freedom from PSA progression compared with no ADT use (51% vs 11%), Dr Deek reported. The 5-year rate of distant recurrence-free survival was 41% for patients who received MDT plus ADT compared with 29% for those who received MDT alone, a significant difference between the groups.

“The addition of concurrent androgen deprivation with metastasis directed therapy appears to be associated with a greater rate of freedom from biochemical progression, though a small group of patients will have sustained biochemical response with metastasis directed therapy alone,” Dr Deek said in an interview. “Future prospective trials are needed to identify the optimal way to integrate hormonal therapy (testosterone suppression and/or potent antiandrogens) with metastasis directed therapy.”

Reference

Deek M, Sutera P, Jing Y, et al. Multi-institutional analysis of metastasis directed therapy with or without androgen deprivation therapy in oligometastatic castration sensitive prostate cancer. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster MP29-03.