Oncological and perioperative outcomes of surgery with or without metastasis-directed therapy as part of a multimodal treatment in men with de-novo oligometastatic prostate cancer

• Published in: World journal of urology 2023-08, Vol.41 (8), p.2069-2076
• Main Authors: Pellegrino, Antony, Gandaglia, Giorgio, de Angelis, Mario, Fallara, Giuseppe, Mazzone, Elio, Stabile, Armando, Pellegrino, Francesco, Robesti, Daniele, Leni, Riccardo, Scuderi, Simone, Cucchiara, Vito, Cirulli, Giuseppe Ottone, Barletta, Francesco, Montorsi, Francesco, Briganti, Alberto
• Format: Article
• Language: English
• Subjects: Complications; Lymph nodes; Medicine; Medicine & Public Health; Metastases; Metastasis; Mortality; Nephrology; Oncology; Patients; Postoperative; Prostate cancer; Prostatectomy; Radiation therapy; Robotic surgery; Surgery; Survival; Topic Paper; Urology
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04460-6

Purpose To investigate the feasibility, safety, and oncological outcomes of Radical Prostatectomy (RP; either Robot-Assisted [RARP] or Open RP [ORP]) in oligometastatic prostate cancer (omPCa). Additionally, we assessed whether there was an added benefit of metastasis-directed therapy (MDT) in these patients in the adjuvant setting. Methods Overall, 68 patients with omPCa (≤ 5 skeletal lesions at conventional imaging) treated with RP and pelvic lymph node dissection between 2006 and 2022 were included. Additional therapies (androgen deprivation therapy [ADT] and MDT) were administered according to the treating physicians’ judgment. MDT was defined as metastasis surgery/radiotherapy within 6 months of RP. We assessed Clinical Progression (CP), Biochemical Recurrence (BCR), post-operative complications and overall mortality (OM) of RP and the impact of adjuvant MDT + ADT versus RP + ADT alone. Results Median follow-up was 73 months (IQR 62–89). RARP reduced the risk of severe complications after adjusting for age and CCI (OR 0.15; p  = 0.02). After RP, 68% patients were continent. Median 90-days PSA after RP was 0.12 ng/dL. CP and OM-free survival at 7 years were 50% and 79%, respectively. The 7-years OM-free survival rates were 93 vs. 75% for men treated with vs. without MDT ( p  = 0.04). At regression analyses, MDT after surgery was associated with a 70% decreased mortality rate (HR 0.27, p  = 0.04). Conclusions RP appeared to represent a safe and feasible option in omPCa. RARP reduced the risk of severe complications. Integrating MDT with surgery in the context of a multimodal treatment might improve survival in selected omPCa patients.