Oligorecurrent PCa

[pjoshea13]

New Mayo study below [1].

"The optimal treatment for oligorecurrent prostate cancer (PCa) is a matter of debate."

"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)."

"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 ...) and EBRT (HR 0.46 ...) were associated with better {radiological recurrence} than ADT.

"Similarly, sLND (HR 0.25 ...) and EBRT (HR 0.41 ...) were associated with longer {second-line systemic therapy}, as compared with ADT.

"Similar results were found for CRPCa status."

Sadly, metastasis-directed therapy "was not associated with survival benefit in patients with bone metastases as compared with ADT."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/332...

Prostate Cancer Prostatic Dis

. 2020 Dec 2. doi: 10.1038/s41391-020-00307-y. Online ahead of print.

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

Luca Boeri 1 2 , Vidit Sharma 3 , Eugene Kwon 3 , Bradley J Stish 4 , Brian J Davis 4 , R Jeffrey Karnes 3

Affiliations collapse

Affiliations

1 Department of Urology, Mayo Clinic, Rochester, MN, USA. [e-mail].

2 Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. [e-mail].

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

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

PMID: 33268854 DOI: 10.1038/s41391-020-00307-y

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.

[Shooter1]

Dang--I've got bone metastases.... maybe they won't recur.

[jdm3]

Thanks Patrick. I don't have the reference at my finger tips, but there are other studies (maybe Johns Hopkins ?) that suggest metastasis-directed therapy does have survival benefits. Hmmm. I suppose it depends on the data sets and how they choose to parse and analyze. We have so many ambiguous or conflicting studies, it's hard to know who is correct. And, ultimately, probably depends on the particulars of the individual being treated.

As an oligometastatic guy who had SBRT, I'm going with survival benefit 😊

[Hidden]

Thanks for posting. I didn't know what sLND was. Learn something new.

This NIH article also discusses detection: pubmed.ncbi.nlm.nih.gov/297...

[paige20180]

My husband was treated at Mayo but started at Hopkins for his PC. Our journey began at Hopkins in 5/17. We live in Northern VA. My husband developed Oligiometastatic PC with less than 5 lesions. ADT was used for a year then ended and when lesions developed SBRT used to take out the few lesions that developed. My husbands lesions got worse and didn’t respond long term to SBRT. Good news he was referred for LU177 by Mayo. I appreciate Mayo referring us overseas. We appreciate the chance to think outside the box. While my husband didn’t have the best outcome until LU177, the LU177 has reduced his PSA undetectable after 2 treatments. I feel, It was worth a try to go the route Mayo offered versus the 5-8 year SOC plan we were offered. Also Mayo has been successful with other men that have great outcomes. My husbands journey is not the same as other men. We have personalities where we would rather go for it. I don’t think there’s a one size fits all for all men.

[Chask]

I may be reading it wrong, but for bone metasteses it appears that the treatment was either MDT or ADT, but not both. In my case it appears that Zytiga has now failed, but with only 2 bone Mets, I am about to start SBRT but my Onco wants me to also continue with Zytiga. His reasoning is that while Zytiga may have reduced effectiveness on my existing mets, it may help to prevent other mets starting up too quickly. Who knows? but I am happy to continue with Zytiga and Zoladex.

[Engraver68 in reply to Chask]

Hi ChaskI am on the same protocol, I have recently completed 5 sessions of SABR treatment in UK on the TRAP Trial. I also am continuing with 6 month injections of Zoldex and daily Zytiga.

10 weeks since treatment and my PSA has reduced from 2.4 - 1.7, going in the right direction!

I have some scans next week as part of the trial and I guess they will indicate any reduction in the 1 metastasis that was treated.

I think like you that the continuation of ADT important as other cancer cells are circulating and lesions are showing on past scans although Oncologist not overly concerned at this stage.

I will stick with this plan as long as PSA is reducing to a acceptable level and decide if any changes are needed when that changes.

My history Prostate removed 2010, followed by radiation 2011 and 8 years Bicalutamide. Commenced Zolodex January 2018 and Zytiga June 2018. Lowest PSA 0.5

👍😀

[mrssnappy]

Thank you for sharing this Patrick. My husband is oligometastatic based on PSMA Scan done at UCLA the end of Oct. We had hoped that spot radiation would be an option, but two radiation oncologist said no because there is also a faint spot showing that had already been treated with salvage radiation. They said systemic treatment was needed. My husband got a Zoladex shot/implant last month. We did not pursue the option of sLND, maybe we should? Just thinking out loud.

[j-o-h-n]

I thought that was a margarine.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 12/06/2020 11:52 PM EST