Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer
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Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer. / Babst, Christa; Amiel, Thomas; Maurer, Tobias; Knipper, Sophie; Lunger, Lukas; Tauber, Robert; Retz, Margitta; Herkommer, Kathleen; Eiber, Matthias; von Amsberg, Gunhild; Graefen, Markus; Gschwend, Juergen; Steuber, Thomas; Heck, Matthias.
In: ASIAN J UROL, Vol. 9, No. 1, 01.2022, p. 69-74.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 - © 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.
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.
U2 - 10.1016/j.ajur.2021.04.003
DO - 10.1016/j.ajur.2021.04.003
M3 - SCORING: Journal article
C2 - 35198399
VL - 9
SP - 69
EP - 74
JO - ASIAN J UROL
JF - ASIAN J UROL
SN - 2214-3882
IS - 1
ER -
