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The impact of locoregional treatments for metastatic castration resistant prostate cancer on disease progression: real life experience from a multicenter cohort

Prostate Cancer and Prostatic Diseases volume 27, pages 89–94 (2024)Cite this article

Subjects

Abstract

Background

Available data on medical treatment of metastatic castration resistant prostate cancer (mCRPC) support the use of more than one therapy line to delay chemotherapy. We evaluate in a longitudinal real life multicenter cohort, the oncological outcome of mCRPC patients treated with Abiraterone Acetate (AA) and Enzalutamide (EZ) in a chemo-naïve setting, who received locoregional treatments for subsequent development of oligorecurrent disease.

Methods

We prospectively collected data on chemo-naïve mCRPC patients, who received either AA or EZ as first or second line treatment between Oct-2012 and Nov-2020 at 5 centers. High-volume disease at mCRPC onset was defined as bulky positive nodes (≥5 cm) or more than 6 bone metastases. Survival probabilities were computed at 12, 24, 48 and 60 months after treatment start. The impact of loco-regional treatments on progression free survival (PFS) were assessed with the Kaplan–Meier method and the log-rank test was applied.

Results

Overall, 117 chemo-naive mCRPC patients received a first line therapy. Fifty-seven (48.7%) patients received AA and 60 (51.3%) received EZ. Eight (6.7%) patients underwent salvage chemotherapy after first line failure. Overall, 28 patients shifted to a second line therapy. Two-yr progression-free, cancer-specific and overall survival probabilities were 65.5%, 82.2% and 78.4% respectively. Since diagnosis of mCRPC, oligo progression occurred in 25 patients who received stereotactic radiation therapy (23/25, 92%) focused on metastasis (4 nodal sites and 19 bones) or salvage lymph node dissection (2/25, 8%). At Kaplan–Meier analysis, patients with low volume disease displayed higher PFS probabilities (log rank p = 0.009) and in this subgroup of patients loco-regional treatments had a significant impact on PFS (p = 0.048), while it was negligible in the whole cohort and in patients with high volume disease (p = 0.6 and p = 0.75).

Conclusions

Low-volume mCRPC patients are exposed to improved PFS and seem to benefit from locoregional treatments.

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Fig. 1: Progression free survival probability according to tumor burden.
Fig. 2: Progression free survival probabilities according to target therapy application.

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Data availability

Data are available if requested.

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Author information

Authors and Affiliations

  1. IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Rome, Italy

    Mariaconsiglia Ferriero, Riccardo Mastroianni, Gabriele Tuderti, Alfredo Maria Bove, Umberto Anceschi, Aldo Brassetti, Leonardo Misuraca, Salvatore Guaglianone & Giuseppe Simone

  2. Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy

    Francesco Prata & Rocco Papalia

  3. Faculty of Health Sciences, “Sapienza” University, Ospedale Sant’Andrea, Department of Urology, Rome, Italy

    Cosimo De Nunzio, Giorgia Tema, Silvana Giacinti & Andrea Tubaro

  4. San Camillo-Forlanini Hospital, Department of Medical Oncology, Rome, Italy

    Fabio Calabrò

  5. “Sapienza” University, Policlinico Umberto I, Department of Urology, Rome, Italy

    Costantino Leonardo & Michele Gallucci

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  1. Mariaconsiglia Ferriero
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Contributions

Conception and design: MF, GS. Acquisition of data: MF, GT, AMB, RM, UA, LM, AB, SG, SGiacinti, GT, CL, CDN, RP, FC. Analysis and interpretation of data: MF, GS. Drafting of the manuscript: MF, FP. Critical revision of the manuscript for important intellectual content: GS. Statistical analysis: MF, GS. Supervision: MG, AT.

Corresponding author

Correspondence to Mariaconsiglia Ferriero.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was performed in accordance with the Declaration of Helsinki. Data were selected from the Institutional Review Board approved prostate cancer database. All patients signed the informed consent for the present study.

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All patients signed the informed consent regarding publishing their data.

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Ferriero, M., Prata, F., Mastroianni, R. et al. The impact of locoregional treatments for metastatic castration resistant prostate cancer on disease progression: real life experience from a multicenter cohort. Prostate Cancer Prostatic Dis 27, 89–94 (2024). https://doi.org/10.1038/s41391-022-00623-5

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