Cytoreductive radical prostatectomy could be a therapeutic option in managing patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), according to study findings presented at the American Society of Clinical Oncology’s 2023 Genitourinary Cancers Symposium in San Francisco, California.
The approach is associated with a low risk for symptomatic local relapse, investigators report.
Axel Heidenreich, MD, of University Hospital of Cologne in Germany, and colleagues analyzed outcomes among 134 men with mHSPC who underwent cytoreductive radical prostatectomy with pelvic lymphadenectomy. Of these, 115 and 19 had low and high metastatic burden, respectively. The men had a mean age of 64.2 years and median follow-up of 53.7 months. All patients received neoadjuvant androgen deprivation therapy (ADT), with 34 receiving ADT alone, 15 receiving ADT plus docetaxel, and 85 receiving ADT plus abiraterone/enzalutamide/apalutamide for 6 months.
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Clavien-Dindo grade 3a-b and 4 complications developed in 13 patients (9.7%) and 2 patients (1.5%), respectively. Cancer-specific survival and clinical progression-free survival rates were 88.1% and 53.0%, respectively. Locally recurrent disease occurred in 3.7%.
Results demonstrated significantly reduced overall survival rates for patients with high vs low metastatic burden (61.9% vs 92.8%) and for those with vs without pathologic node-positive disease (85.7% vs 96.7%).
In addition, clinical T stage 3b or higher disease (vs lower stages) and high vs low metastatic burden were significantly associated with 2.2- and 2.3-fold increased risks for clinical progression, respectively.
The investigators found no significant difference between ADT type and final pathohistology.
Cytoreductive radical prostatectomy can be performed with minimal morbidity, the authors concluded, noting that patients with low metastatic burden and a good response to neoadjuvant ADT benefit most from this approach.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Heidenreich A, Rieger C, Kastner L, Seelemeyer F, Pfister D. Cytoreductive radical prostatectomy (cRP) in the management of patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). Presented at: ASCO GU 2023, San Francisco, California, February 16-18. Abstract 161.
