PD27-03 RADICAL PROSTATECTOMY AS A COMPONENT OF MULTIMODAL THERAPY FOR HIGHLY-SELECTED M1 PROSTATE CANCER PATIENTS (2014)

You have accessJournal of UrologyProstate Cancer: Advanced I1 Apr 2014PD27-03 RADICAL PROSTATECTOMY AS A COMPONENT OF MULTIMODAL THERAPY FOR HIGHLY-SELECTED M1 PROSTATE CANCER PATIENTS Matthew J. O'Shaughnessy, Karim A. Touijer, James A. Eastham, Bernard H. Bochner, Vincent P. Laudone, Peter T. Scardino, and Howard I. Scher Matthew J. O'ShaughnessyMatthew J. O'Shaughnessy More articles by this author , Karim A. TouijerKarim A. Touijer More articles by this author , James A. EasthamJames A. Eastham More articles by this author , Bernard H. BochnerBernard H. Bochner More articles by this author , Vincent P. LaudoneVincent P. Laudone More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , and Howard I. ScherHoward I. Scher More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2102AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men who present with limited metastasis at the time of prostate cancer (PCa) diagnosis are typically managed with systemic therapy alone and the primary site of disease is not addressed. The recent approval of five diverse agents in advanced metastatic PCa presents the opportunity to potentially cure patients (pts) with lesser disease burdens as has been shown in other tumor types. We report a multimodal approach including androgen deprivation therapy (ADT), radical prostatectomy (RP), and directed radiotherapy (RT) to select patients with oligometastatic disease in bone to maximize local and systemic cancer control. METHODS We reviewed our experience of 20 pts treated with RP as a component of multimodal therapy for newly diagnosed metastatic PCa. Baseline characteristics, details of management, surgical outcomes, and disease progression defined as initiation of chemotherapy, new metastasis, or reinitiation of ADT were characterized. RESULTS Of 20 pts with median age 61.0 years; 60% were ≥ cT3a and 75% were cN1. Metastatic burden was assessed with whole body MRI or PET-CT. 17 of 20 pts had bone metastases (median 1.0, IQR 1.0-2.5) and 7 of 20 pts had retroperitoneal node metastases. No pts had visceral metastases. All pts had RP and pelvic lymph node dissection; 4 pts also had retroperitoneal lymph node dissection. There was one grade III surgical complication (pelvic abscess). At last follow-up, 17 pts (85%) were completely continent with median time to continence 3.3 months (mo) (IQR 1.6-9.1). Patients received RT to bone metastases (n=10), bone and pelvis (n=4), or no RT (n=6). ADT was stopped at average of 8.5 mo in 11 pts who had stable disease while 4 pts had continuous ADT due to disease progression and 5 pts did not yet complete initial ADT course. At median follow-up of 20.2 mo (IQR 14.3-45.0) since RP in the 15 pts who completed initial ADT course, 6 (40%) had no evidence of disease progression, 5 (33%) progressed after stopping ADT, and 4 (27%) progressed on ADT. 5 of 6 pts without progression had mean serum testosterone level of 336 ng/dL at last follow-up with 1 patient still castrate. There were no local recurrences after surgery. CONCLUSIONS Multimodal therapy that includes RP is well-tolerated and enables definitive staging and a more accurate determination of prognosis. It may be beneficial to select patients with limited stage M1 PCa, specifically those who have a complete response to initial treatment and may be able to discontinue ADT thus avoiding long-term morbidity. Further evaluation of this therapeutic strategy should be considered in a clinical trial. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e765 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Matthew J. O'Shaughnessy More articles by this author Karim A. Touijer More articles by this author James A. Eastham More articles by this author Bernard H. Bochner More articles by this author Vincent P. Laudone More articles by this author Peter T. Scardino More articles by this author Howard I. Scher More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...