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Oligorecurrent prostate cancer treated with metastases-directed therapy or standard of care: a single-center experience

Prostate Cancer and Prostatic Diseases volume 24, pages 514–523 (2021)Cite this article

Subjects

Abstract

Background:

The optimal treatment for oligorecurrent prostate cancer (PCa) is a matter of debate. We aimed to assess oncologic outcomes of patients treated with metastasis-directed therapy (MDT) vs. androgen deprivation therapy (ADT) for oligorecurrent PCa.

Methods:

We analyzed data from patients with oligorecurrent PCa treated with ADT (n = 121), salvage lymph node dissection (sLND) (n = 191) or external beam RT (EBRT) (n = 178). Radiological recurrence (RAR) was defined as a positive positron emission tomography imaging after MDT or ADT. Second-line systemic therapies (SST) were defined as any systemic therapy administered for progression. Oncologic outcomes were evaluated separately for patients with node-only or bone metastases. Kaplan–Meier method was used to assess time to RAR, SST, and cancer-specific mortality (CSM). Predictors of RAR, SST, and castration-resistant PCa (CRPCa) were assessed with Cox regression analyses.

Results:

Overall, 74 (22.6%), 63 (19.2%), and 191 (58.2%) patients were treated with ADT, EBRT, and sLND for lymph node-only recurrence. Both sLND (HR 0.56, 95% CI 0.33–0.94) and EBRT (HR 0.46, 95% CI 0.25–0.85) were associated with better RAR than ADT. Similarly, sLND (HR 0.25, 95% CI 0.13–0.50) and EBRT (HR 0.41, 95% CI 0.19–0.87) were associated with longer SST, as compared with ADT. Similar results were found for CRPCa status. Oncologic outcomes were similar between sLND and EBRT. MDT was not associated with survival benefit in patients with bone metastases as compared with ADT.

Conclusions:

sLND and EBRT were associated with better RAR, SST, and CRPCa-free survival as compared with ADT in patients with oligometastatic PCa nodal recurrence. No difference in survival outcomes was observed between sLND and EBRT. MDT was not associated with survival benefit in patients with bone metastases, as compared with ADT.

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Acknowledgements

This publication was made possible by CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The funding organization had a role in the design and conduct of the study; collection, management, analysis, interpretation, preparation, and review of the data; and approval of the manuscript. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

Author contributions

LB collected data, wrote the manuscript. VS collected data, supervised manuscript drafting. EK, BJS, BJD, and RJK collected data, supervision, final approval of the manuscript.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Luca Boeri, Vidit Sharma, Eugene Kwon & R. Jeffrey Karnes

  2. Department of Urology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Luca Boeri

  3. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Bradley J. Stish & Brian J. Davis

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Correspondence to Luca Boeri.

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Boeri, L., Sharma, V., Kwon, E. et al. Oligorecurrent prostate cancer treated with metastases-directed therapy or standard of care: a single-center experience. Prostate Cancer Prostatic Dis 24, 514–523 (2021). https://doi.org/10.1038/s41391-020-00307-y

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