Oncological Outcome of Combining Cytoreductive Prostatectomy and Metastasis-Directed Radiotherapy in Patients with Prostate Cancer and Bone Oligometastases: A Retrospective Cohort Study

Peng Xue,1 Ziyu Wu,2 Kunpen Wang,1 Guojun Gao,3 Min Zhuang,4 Miao Yan4 1Department of Urology, First People Hospital of Lianyungang, Lianyungang, Jiangsu Province, People’s Republic of China; 2Department of Urology, NO 2 Hospital of Huaian, Huaian, Jiangsu Province, People’s Republic of China; 3Department of Urology, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong Province, People’s Republic of China; 4Department of Oncology, First People Hospital of Lianyungang, Lianyungang, Jiangsu Province, People’s Republic of ChinaCorrespondence: Miao YanDepartment of Oncology, First People Hospital of Lianyungang, Zhenghua Road 6, Lianyungang, Jiangsu Province 222002, People’s Republic of ChinaTel +86051885605016Email yanmiao_ym@126.comBackground: The current standard of care for metastatic prostate cancer (mPCa) is androgen deprivation therapy (ADT) with or without anti-androgen and chemotherapy. The aim of this study was to evaluate the efficacy and safety of a multimodal approach including local primary tumor therapy, metastasis-directed therapy (MDT), and hormonal therapy in patients with oligometastatic prostate cancer (PCa).Methods: We reviewed data of patients with PCa and bone oligometastases at diagnosis treated in three institutions with ADT followed by cytoreductive surgery with or without metastases-directed radiotherapy. Oligometastases were defined as the presence of five or fewer metastatic lesions with the absence of visceral metastases. In this retrospective cohort study, 58 patients underwent cytoreductive radical prostatectomy and ADT. Of these, 26 patients (45%) received stereotactic body radiation therapy (SBRT) to all metastatic sites as a MDT. Oncological outcomes were analyzed using the Kaplan–Meier method.Results: The median follow-up period was 46.2 months. Of the 58 patients, the 3-year castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival was 75.9% and 91.4%, respectively. Pre- or post-treatment predictive factors for progression to CRPC, including prostate-specific antigen (PSA) level at diagnosis ≥ 20 ng/mL, Gleason grade groups 5, clinical T stage cT3b-4, PSA nadir level of ≥ 0.05 ng/mL, and no MDT with SBRT, were significantly associated with progression to CRPC. Subgroup analysis showed that the MDT group had significantly better CRPC-free survival than the non-MDT group with Gleason grade groups 1– 4 (HR=0.228; 95% CI= 0.056– 0.926). A total of 3.4% of the patients had grade 2 acute genitourinary toxicities and 5.2% had grade 2 acute gastrointestinal toxicities. No late grade > 2 adverse events were observed.Conclusion: This multi-center, retrospective cohort study revealed the feasibility of combining cytoreductive prostatectomy and metastasis-directed radiotherapy for newly-diagnosed oligometastatic PCa. This treatment strategy has the potential to delay the progression to CRPC.Keywords: oligometastases, prostate cancer, stereotactic body radiotherapy, androgen deprivation therapy, radical prostatectomy, metastasis-directed therapy