Local Treatment in the Management of Oligometastatic Prostate Cancer

2018 ◽  
Author(s):  
Derya Tilki ◽  
Christopher P Evans
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Metastatic Prostate Cancer ◽  
Randomized Clinical Trials ◽  
Retrospective Studies ◽  
Local Treatment ◽  
Oncologic Outcomes ◽  
Newly Diagnosed ◽  
Oligometastatic Prostate Cancer ◽  
Treatment Paradigm

Oncologic outcomes of patients with newly diagnosed metastatic prostate cancer (mPCa) are poor, with overall survival in the range of 44 to 60 months. The treatment paradigm for newly diagnosed mPCa is changing. Previous retrospective studies reported a survival benefit for local treatment (radical prostatectomy or radiotherapy) in addition to androgen deprivation treatment in the setting of oligometastatic prostate cancer. Several randomized clinical trials are now evaluating integration of local treatment in the approach to mPCa. The aim of this review is to summarize the studies reporting local treatment in men with mPCa at diagnosis. This review contains 1 table and 27 references.  Key Words: cytoreductive prostatectomy, hormone-naive, local treatment, metastatic prostate cancer, oligometastatic, radical prostatectomy, radiotherapy, randomized

Management of Metastatic Castrate-sensitive Prostate Cancer

2018 ◽  
Author(s):  
Derya Tilki ◽  
Marc A Dall’era ◽  
Christopher P Evans
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Survival Benefit ◽  
Metastatic Prostate Cancer ◽  
Oncologic Outcome ◽  
Standard Of Care ◽  
Abiraterone Acetate ◽  
Androgen Deprivation ◽  
Newly Diagnosed ◽  
Treatment Paradigm

Oncologic outcome of patients with newly diagnosed metastatic prostate cancer (mPCa) is poor. The treatment paradigm for newly diagnosed mPCa has changed. The standard of care for men with metastatic hormone-naive prostate cancer has been systemic androgen deprivation therapy (ADT). Previous randomized studies demonstrated an overall survival benefit by the addition of early chemotherapy with six cycles of docetaxel. More recently, results from randomized trials also demonstrated a survival benefit by the addition of abiraterone acetate to the ADT in men with metastatic disease. The aim of this review is to summarize the results from most recent studies, including men with newly diagnosed metastatic hormone-naive prostate cancer, focusing on chemotherapy and ADT. This review contains 1 figure, 2 tables, and 47 references.  Key Words: abiraterone acetate, androgen deprivation therapy, androgen deprivation, castrate sensitive, chemotherapy, continuous androgen deprivation, docetaxel, hormone-naive, intermittent androgen deprivation, metastatic prostate cancer

Androgen-deprivation therapy plus docetaxel-based chemotherapy in metastatic hormone-sensitive prostate cancer. A meta-analysis of randomized clinical trials.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 188-188 ◽  
Author(s):  
Allan Ramos-Esquivel ◽  
Joao M. Baptista ◽  
Luis Corrales-Rodriguez ◽  
Ileana Gonzðlez ◽  
Melissa Juarez Villegal ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Androgen Deprivation Therapy ◽  
Metastatic Prostate Cancer ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Androgen Deprivation ◽  
Cochrane Central Register ◽  
Newly Diagnosed ◽  
Hormone Sensitive

188 Background: Androgen-deprivation therapy (ADT) is the standard of treatment for patients with newly diagnosed metastatic prostatic cancer. Nevertheless, recent trials have suggested a role for chemotherapy in these patients. We performed a systematic review and meta-analysis to assess the efficacy and safety of docetaxel-based chemotherapy in combination with ADT for patients with hormone-sensitive metastatic prostate cancer. Methods: Randomized clinical trials (RCT) were identified after systematic searching of electronic databases (MEDLINE, OVID and The Cochrane Central Register of Controlled Trials), as well as ASCO conference proceedings from 2010 to 2015. We included only RCT comparing ADT versus the combination of ADT plus docetaxel-based chemotherapy in patients with newly diagnosed metastatic prostate cancer. A random-effect model was used to determine the pooled hazard ratio (HR) for the efficacy outcomes: overall survival (OS) and clinical progression-free survival (PFS), according to the inverse-variance method. Heterogeneity was measured using the Q and I2statistics. Results: Three RCT (n = 2 262), were included in our meta-analysis (E3805, GETUG-AFU 15 and the M1 subgroup from STAMPEDE Trial). Docetaxel-based chemotherapy plus ADT was associated with improved OS (HR: 0.74; 95% CI: 0.60-0.90; p = 0.003). The heterogeneity of these trials was moderate (Tau2: 0.02; I2: 51%; p = 0.13). Clinical PFS was also significantly better in patients receiving docetaxel-based chemotherapy (HR: 0.67; 95% CI 0.55-0.82; p = 0.0001), with moderate between-study heterogeneity detected (Tau2: 0.01; I2: 42%; p = 0.19). Different subset of patients in these trials can explain the aforementioned heterogeneity. Regarding adverse drug reactions grade 3 or higher, neutropenia was reported in a range from 36% in the GETUG-AFU 15 Trial to 12% in the STAMPEDE trial and febrile neutropenia was reported from 6.1% in the E3805 Trial to 12% in the STAMPEDE Trial. Conclusions: The addition of docetaxel-based chemotherapy to ADT improves OS and clinical PFS. New trials are needed to determine which patients benefit the most from this intervention.

scholarly journals MP24-10 NEWLY-DIAGNOSED LOW-VOLUME METASTATIC PROSTATE CANCER; IS THERE A PLACE FOR CYTOREDUCTIVE RADICAL PROSTATECTOMY?

2021 ◽  
Vol 206 (Supplement 3) ◽  
Author(s):  
Elise De Bleser ◽  
Nicolaas Lumen ◽  
Sarah Buelens ◽  
Wesley Verla ◽  
Wietse Claeys ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Metastatic Prostate Cancer ◽  
Newly Diagnosed ◽  
Low Volume

Survival trends in patients diagnosed with metastatic prostate cancer: A nationwide analysis.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 171-171
Author(s):  
John Thomas Helgstrand ◽  
Nina Klemann ◽  
Birgitte Grønkaer Toft ◽  
Ben Vainer ◽  
Klaus Brasso ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lead Time ◽  
Metastatic Prostate Cancer ◽  
Randomized Clinical Trials ◽  
Patient Characteristics ◽  
Newly Diagnosed ◽  
The Past ◽  
Specific Mortality ◽  
Cox Analysis ◽  
The Impact

171 Background: The risk of prostate cancer (PCa)-death in men diagnosed with metastatic (M+) PCa is high. During the past decade, new life-prolonging therapies have been approved for the treatment of advanced PCa. Even though demonstrated in randomized clinical trials, the impact of these advancements on mortality of men with newly diagnosed M+ PCa has not been described in a nation-wide setting. Methods: In the Danish Prostate Cancer Registry (DaPCaR), all men diagnosed with M+ PCa in Denmark from 1995 to 2011 were identified. Patients were grouped according to the year of diagnosis; 1995-2000, 2001-2005 and 2006-2011. In a competing risk setting, the 5-year cumulative incidences of PCa, other-cause, and overall death were calculated. Multivariate cause-specific Cox analysis was performed. Results: A total of 1,892 (1995-2000), 2,329 (2001-2005), and 2,653 (2006-2011) men were included (total: 6,874). Patient characteristics at diagnosis showed essential differences as median age and median PSA decreased by 1.0 year (74.1 to 73.1) and 134 ng/mL (276 to 142), respectively, in the period studied. The 5-year PCa-specific mortality decreased by 17.0% from 72.8% (1995-2000) (95%CI: 70.8% – 74.8%) to 55.8% (2006-2011) (95%CI: 53.9% – 57.7%), p < 0.0001. The 5-year other-cause mortality increased by 5.7% from 11.4% (95%CI: 9.9% – 12.8%) to 17.1% (95%CI: 15.6 – 18.6), p < 0.0001. The risk of PCa-death decreased for patients diagnosed in 2000-2005; HR: 0.69 (95%CI 0.61-0.79) and for patients diagnosed in 2006-2011; HR: 0.53 (95%CI 0.47-0.61) compared to patients diagnosed in 1995-2000, when adjusting for age, PSA, and Gleason score (GS) in the statistical analysis. Conclusions: A significant reduction in 5-year PCa-specific mortality was observed in a nationwide cohort of patients diagnosed with M+ PCa since 1995. Changes in age and PSA at diagnosis suggest that lead-time introduced by increased PSA use may have affected the results. However, in multivariate analysis, a significant reduction in hazard of almost 50% was observed when adjusting for age, PSA, and GS. Only minor changes in other cause mortality were found, which suggests that the improvement to a large extend can be credited to improved management of men with advanced PCa.

scholarly journals Results of Phase 1 study on cytoreductive radical prostatectomy in men with newly diagnosed metastatic prostate cancer

2019 ◽  
Vol 7 (3) ◽  
pp. 102-107 ◽  
Author(s):  
Bertram E. Yuh ◽  
Young Suk Kwon ◽  
Brian M. Shinder ◽  
Eric A. Singer ◽  
Thomas L. Jang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Metastatic Prostate Cancer ◽  
Phase 1 ◽  
Newly Diagnosed ◽  
Phase 1 Study

scholarly journals Survival outcomes for metastatic prostate cancer patients treated with radical prostatectomy or radiation therapy —— A SEER based study

2019 ◽  
Author(s):  
Kun Jin ◽  
Shi Qiu ◽  
Shiyu Zhang ◽  
Xiaonan Zheng ◽  
Xiang Tu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Multivariate Regression ◽  
Metastatic Prostate Cancer ◽  
Local Treatment ◽  
Hazard Ratios ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Adjusted Model

Abstract Background Patients appeared as metastatic prostate cancer (mPCa) have a very low 5-year-survival rate. How to choose proper treatment of mPCa remained controversial.Method Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015), we performed analyses of cancer specific mortality (CSM) and overall mortality (OM) in the comparisons of local treatment (LT) vs no local treatment (NLT) and radical prostatectomy (RP) vs radiation therapy (RT). To balance the characteristics between two treatment groups, propensity score matching were performed. Considering the selection bias, we additionally used an instrument variate (IVA) to calculate the unmeasured confounders.Result Our study selected mPCa patients with average age more than 60 yr, high level of PSA, and tend to present as high GS. Multivariate regression showed that patients received LT had the lower risks of OM and CSM after adjustment of covariates (HR=0.39, 95% CI 0.35-0.44 and HR=0.39, 95% CI 0.34-0.45). In the IV-adjusted model, LT showed more survival benefits compared with NLT, with hazard ratios of 0.57 (95% CI 0.50-0.65) and cancer specific hazard ratios of 0.59 (95% CI 0.51-0.68), respectively. For those received LT, adjusted multivariate regression indicated that RP is superior to RT, (HR=0.60 [95% CI 0.43-0.83] for OM and HR=0.61 [95% CI 0.42-0.91] for CSM). The IV-adjusted model also showed that RP presented with potentially better survival outcome compared with RT, although the effect was not statistically significant (HR=0.63 [95% CI 0.26-1.54] for OM and HR=0.47 [95% CI 0.16-1.35] for CSM).Conclusion Among patients with metastatic prostate cancer, local treatment might bring better survival benefits in decreasing cancer-specific mortality and all-cause mortality compared with non-local treatment. For those received LT, radical prostatectomy showed better survival outcomes than radiation therapy.

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