Does Cytoreductive Prostatectomy Really Have an Impact on Prognosis in Prostate Cancer Patients with Low-volume Bone Metastasis? Results from a Prospective Case-Control Study

TY - JOUR

T1 - Does Cytoreductive Prostatectomy Really Have an Impact on Prognosis in Prostate Cancer Patients with Low-volume Bone Metastasis? Results from a Prospective Case-Control Study

AU - Steuber, Thomas

AU - Berg, Kasper D.

AU - Røder, Martin A.

AU - Brasso, Klaus

AU - Iversen, Peter

AU - Huland, Hartwig

AU - Tiebel, Anne

AU - Schlomm, Thorsten

AU - Haese, Alexander

AU - Salomon, Georg

AU - Budäus, Lars

AU - Tilki, Derya

AU - Heinzer, Hans

AU - Graefen, Markus

AU - Mandel, Philipp

PY - 2017

Y1 - 2017

N2 - The impact of cytoreductive radical prostatectomy (CRP) on oncological outcomes in patients with prostate cancer (PCa) and distant metastases has been demonstrated by retrospective data with their potential selection bias. Using prospective institutional data, we compared the outcomes between 43 PCa patients with low-volume bone metastases (1–3 lesions) undergoing CRP (median follow-up 32.7 mo) and 40 patients receiving best systemic therapy (BST; median follow-up 82.2 mo). The inclusion criteria for both cohorts were identical. So far, no significant difference in castration resistant–free survival (p = 0.92) or overall survival (p = 0.25) has been detected. Compared to recent reports, the outcomes for our control group are more favorable, indicating a potential selection bias in the previous retrospective studies. Therefore, the unclear oncological effect has to be weighed against the potential risks of CRP. However, patients benefit from a significant reduction in locoregional complications (7.0% vs 35%; p < 0.01) when undergoing CRP. Patient summary: In this study we analyzed the impact of surgery in patients with prostate cancer and bone metastases. Using prospective data, we could not show a significant benefit of surgery on survival, but the rate of locoregional complications was lower. Therefore, patients should be treated within prospective trials evaluating the role of cytoreductive prostatectomy in low-volume, bone metastatic prostate cancer. Using prospective data comparing cytoreductive prostatectomy in patients with low-volume bone metastases compared to best systemic therapy, we could not observe a positive effect on oncological outcome, but there was a lower rate of locoregional complications. Therefore, patients should be included in ongoing clinical trials.

AB - The impact of cytoreductive radical prostatectomy (CRP) on oncological outcomes in patients with prostate cancer (PCa) and distant metastases has been demonstrated by retrospective data with their potential selection bias. Using prospective institutional data, we compared the outcomes between 43 PCa patients with low-volume bone metastases (1–3 lesions) undergoing CRP (median follow-up 32.7 mo) and 40 patients receiving best systemic therapy (BST; median follow-up 82.2 mo). The inclusion criteria for both cohorts were identical. So far, no significant difference in castration resistant–free survival (p = 0.92) or overall survival (p = 0.25) has been detected. Compared to recent reports, the outcomes for our control group are more favorable, indicating a potential selection bias in the previous retrospective studies. Therefore, the unclear oncological effect has to be weighed against the potential risks of CRP. However, patients benefit from a significant reduction in locoregional complications (7.0% vs 35%; p < 0.01) when undergoing CRP. Patient summary: In this study we analyzed the impact of surgery in patients with prostate cancer and bone metastases. Using prospective data, we could not show a significant benefit of surgery on survival, but the rate of locoregional complications was lower. Therefore, patients should be treated within prospective trials evaluating the role of cytoreductive prostatectomy in low-volume, bone metastatic prostate cancer. Using prospective data comparing cytoreductive prostatectomy in patients with low-volume bone metastases compared to best systemic therapy, we could not observe a positive effect on oncological outcome, but there was a lower rate of locoregional complications. Therefore, patients should be included in ongoing clinical trials.

KW - Bone metastases

KW - Castration-resistant prostate cancer

KW - Cytoreductive radical prostatectomy

KW - Oncological outcome

U2 - 10.1016/j.euf.2017.06.016

DO - 10.1016/j.euf.2017.06.016

M3 - Letter

C2 - 28753877

AN - SCOPUS:85021702062

SN - 2405-4569

VL - 3

SP - 646

EP - 649

JO - European Urology Focus

JF - European Urology Focus

IS - 6

ER -