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The following article features coverage from the American Urological Association (AUA) 2019 meeting. <a href=”https://www.renalandurologynews.com/home/conference-highlights/aua-2019-coverage/”>Click here to read more of <i>Renal & Urology News'</i> conference coverage.</a>
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CHICAGO—Men with synchronous oligometastatic prostate cancer (PCa) can be safely randomized to robotic-assisted radical prostatectomy (RARP) and extended pelvic lymphadenectomy after starting standard of care systemic therapy, according to findings from the TRoMbone feasibility study presented at the 2019 American Urological Association annual meeting.

Recruitment for TRoMbone (Testing Radical prostatectomy in men with oligoMetastatic prostate cancer that has spread to the bone) was completed ahead of schedule, Prasanna Sooriakumaran, MD, PhD, of the University College London Hospital in the United Kingdom, reported. Fifty-one patients with 1 to 3 skeletal metastases on conventional imaging, who were younger than 75 years and had good performance status (ECOG PS 0-1) were randomly assigned to standard of care (androgen deprivation [ADT] with or without docetaxel chemotherapy) or locally-directed surgery plus standard of care. All received ADT and 60% of intervention patients received docetaxel preoperatively. One patient in both the intervention group dropped out.

Eight surgeons successfully performed the RARPs. No cases were abandoned. The median operative time was 3 hours 5 minutes, length of stay 2 days, and catheterization 14 days. Complications included a rectal injury that was repaired intraoperatively with primary closure, 1 blood transfusion, and 1 infected lymphocele resulting in pericarditis and readmission. At a median 3 months, 74% of patients were continent (0-1 pads per day).

At 3 months, intervention patients reported better quality of life than controls on the EQ-5D: 90 vs 84. Satisfaction scores were high even in those who received ADT, docetaxel, and RP.

“It is safe and technically feasible to operate on men with low volume metastatic prostate cancer, both before and after chemotherapy,” Dr Sooriakumaran told Renal & Urology News. “Men achieve good continence recovery and have excellent quality of lives after the operation.”

The current study is a precursor to a large randomized controlled trial examining whether surgery for men with oligometastatic prostate cancer has oncologic benefit, as seen for radiation therapy in the STAMPEDE trial, Dr Sooriakumaran added. “As a result of the TRoMbone study, STAMPEDE is proposing to include surgery in its next intervention arm specific to oligometastatic patients, and I will be leading that surgical investigation.”

TRoMbone is funded by the Prostate Cancer Foundation and The Urology Foundation.

Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.

Reference

Sooriakumaran P, Rajan P, Al Kadhi O, et al. Testing radical prostatectomy in men with prostate cancer and oligoMetastases to the bone (TRoMbone): a randomized controlled feasibility trial. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract PD15-09.