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•This retrospective study reports the clinical outcomes of patients with castration-resistant prostate cancer treated with metastasis-directed therapy (MDT) with stereotactic ablative radiotherapy. In 68 patients with oligoprogressive disease, the median time to PSA failure was 9.7 months and distant metastasis–free survival was 10.8 months. Local failure at 12 and 24 months were 2.1% and 13.8%, associated with age (P = .03) and Gleason grade group (P = .07).
•Despite the limitations inherent in a single-institution retrospective study, MDT was associated with favorable outcomes and cancer control. Emerging data with MDT as shown in this dataset require further validation in prospective studies
– Pedro C. Barata, MD
BACKGROUND.
Available therapies for castrate-resistant prostate cancer (CRPC) confer minimal survival advantage; thus, there is interest in metastasis-directed therapy (MDT) for oligometastatic or oligoprogressive disease to improve outcomes. Here, we describe outcomes of oligoprogressive CRPC treated with stereotactic ablative radiotherapy (SABR).
OBJECTIVE.
To report outcomes of oligoprogressive CRPC treated with MDT using SABR.
Design, setting, and participants: Patients with oligoprogressive CRPC were retrospectively evaluated, and outcomes following MDT were reported. Outcomes were additionally compared with oligoprogressive CRPC treated with change in systemic therapy alone.
INTERVENTION.
Outcome measurements and statistical analysis
Outcomes of interest were time to prostate-specific antigen (PSA) failure, time to next intervention (TTNI), distant metastasis-free survival (DMFS), and overall survival. Survival analysis was performed using the Kaplan-Meier method, and univariable analysis and multivariable analysis (MVA) were performed.
RESULTS AND LIMITATIONS.
A total of 68 patients were included. After MDT, median time to PSA recurrence, TTNI, and DMFS were 9.7, 15.6, and 10.8 months, respectively. A total of 112 lesions were treated, and the cumulative incidences of local failure at 12 and 24 months were 2.1% and 13.8%, respectively. Factors associated with the risk of local recurrence on univariable analysis were age (hazard ratio [HR] 1.07, p = 0.03) and Gleason grade group (HR 2.20, p = 0.07). Compared with change in systemic therapy alone (n = 52), MDT (n = 31) was associated with improved median time to PSA failure (9.7 vs 4.2 months, p = 0.066)), TTNI (14.9 vs 8.8 months, p = 0.025), and DMFS (12.7 vs 8.9 months, p = 0.045), and remained associated with improved outcomes on MVA.
CONCLUSIONS.
In a retrospective cohort of oligoprogressive CRPC patients, MDT was associated with favorable outcomes and improved cancer control as compared with change in systemic treatment alone. Future prospective trials are needed to confirm these findings.
European Urology Oncology
Metastasis-Directed Therapy Prolongs Efficacy of Systemic Therapy and Improves Clinical Outcomes in Oligoprogressive Castration-Resistant Prostate Cancer
Eur Urol Oncol 2020 Jun 11;[EPub Ahead of Print], MP Deeka, K Taparrab, R Phillips, et al
Updated trial fails to show any real benefit to metastasis-directed therapy (MDT) in oligometastatic patients
Perineural invasion increases soft tissue progression risk in metastatic castration-resistant prostate cancer post-abiraterone resistance
Oligometastatic prostate cancer: Metastases-directed therapy?
