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Rans K, Charlien B, Filip A, Olivier DH, Julie DH, Céderic D, Herlinde D, Benedikt E, Karolien G, Annouschka L, Nick L, Kenneth P, Carl S, Koen S, Hans V, Ben V, Steven J, Gert DM. SPARKLE: a new spark in treating oligorecurrent prostate cancer: adding systemic treatment to stereotactic body radiotherapy or metastasectomy: key to long-lasting event-free survival? BMC Cancer 2022; 22:1294. [PMID: 36503429 PMCID: PMC9743623 DOI: 10.1186/s12885-022-10374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Metastasis-directed therapy (MDT) significantly delays the initiation of palliative androgen deprivation therapy (pADT) in patients with oligorecurrent prostate cancer (PCa) with a positive impact on patient's quality of life. However, it remains unclear whether the addition of ADT improves polymetastatic free survival (PMFS) and metastatic castration refractory PCa-free survival (mCRPC-FS) and how long concomitant hormone therapy should be given. A significant overall survival (OS) benefit was shown when an androgen receptor targeted agent (ARTA) was added to pADT in patients with metastatic hormone sensitive PCa (HSPC). However, whether the addition of and ARTA to MDT in the treatment of oligorecurrent PCa results in better PMFS and mCRPC-FS has not been proven yet. METHODS & DESIGN Patients diagnosed with oligorecurrent HSPC (defined as a maximum of 5 extracranial metastases on PSMA PET-CT) will be randomized in a 1:1:1 allocation ratio between arm A: MDT alone, arm B: MDT with 1 month ADT, or arm C: MDT with 6 months ADT together with ARTA (enzalutamide 4 × 40 mg daily) for 6 months. Patients will be stratified by PSA doubling time (≤ 3 vs. > 3 months), number of metastases (1 vs. > 1) and initial localization of metastases (M1a vs. M1b and/or M1c). The primary endpoint is PMFS, and the secondary endpoints include mCRPC-FS, biochemical relapse-free survival (bRFS), clinical progression free survival (cPFS), cancer specific survival (CSS), overall survival (OS), quality of life (QOL) and toxicity. DISCUSSION This is the first prospective multicentre randomized phase III trial that investigates whether the addition of short-term ADT during 1 month or short-term ADT during 6 months together with an ARTA to MDT significantly prolongs PMFS and/or mCRPC-FS. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05352178, registered April 28, 2022.
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Affiliation(s)
- Kato Rans
- grid.410569.f0000 0004 0626 3338Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Berghen Charlien
- grid.410569.f0000 0004 0626 3338Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Ameye Filip
- grid.420034.10000 0004 0612 8849Department of Urology, AZ Maria Middelares Ghent, Ghent, Belgium
| | - De Hertogh Olivier
- Department of Radiotherapy, Centre Hospitalier Régional de Verviers, Verviers, Belgium
| | - den Hartog Julie
- grid.410569.f0000 0004 0626 3338Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Draulans Céderic
- grid.410569.f0000 0004 0626 3338Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Dumez Herlinde
- grid.5596.f0000 0001 0668 7884Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Engels Benedikt
- grid.478056.80000 0004 0439 8570Department of Radiation Oncology, AZ Delta Roeselare-Menen-Torhout, Roeselare, Belgium
| | - Goffin Karolien
- grid.410569.f0000 0004 0626 3338Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Laenen Annouschka
- grid.5596.f0000 0001 0668 7884Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium
| | - Liefhooghe Nick
- grid.420028.c0000 0004 0626 4023Department of Radiation Oncology, AZ Groeninge, Kortrijk, Belgium
| | - Poels Kenneth
- grid.410569.f0000 0004 0626 3338Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Salembier Carl
- grid.459485.10000 0004 0614 4793Department of Radiotherapy, Europe Hospitals Brussels, Brussels, Belgium
| | | | | | - Vanneste Ben
- grid.410566.00000 0004 0626 3303Department of Human Structure and Repair; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joniau Steven
- grid.410569.f0000 0004 0626 3338Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - De Meerleer Gert
- grid.410569.f0000 0004 0626 3338Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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2
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Chiong E, Murphy DG, Buchan NC, Chua MLK, Hakim L, Hamid AR, Hong SK, Horvath LG, Kanesvaran R, Khochikar M, Letran J, Lojanapiwat B, Malek R, Ng ACF, Vinh NT, Pang S, Poon DMC, Ong TA, Saad M, Schubach K, Shiroki R, Türkeri L, Williams S, Wong A, Ye D, Davis ID. Managing advanced prostate cancer in the Asia Pacific region: "Real-world" application of Advanced Prostate Cancer Consensus Conference 2019 statements. Asia Pac J Clin Oncol 2022; 18:686-695. [PMID: 35134266 PMCID: PMC9790439 DOI: 10.1111/ajco.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/27/2021] [Indexed: 12/30/2022]
Abstract
AIM The second Asia-Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2020) gathered insights into the real-world application in the Asia-Pacific (APAC) region of consensus statements from the 3rd Advanced Prostate Cancer Consensus Conference (APCCC 2019). METHODS The 4-h our virtual meeting in October 2020 brought together 26 experts from 14 APAC countries to discuss APCCC 2019 recommendations. Presentations were prerecorded and viewed prior to the meeting. A postmeeting survey gathered views on current practice. RESULTS The meeting and survey highlighted several developments since APAC APCCC 2018. Increased access and use in the region of PSMA PET/CT imaging is providing additional diagnostic and staging information for advanced prostate cancer and influencing local and systemic therapy choices. Awareness of oligometastatic disease, although not clearly defined, is increasing. Novel androgen receptor pathway antagonists are expanding treatment options. Cost and access to contemporary treatments and technologies continue to be a significant factor influencing therapeutic decisions in the region. With treatment options increasing, multidisciplinary treatment planning, shared decision making, and informed choice remain critical. A discussion on the COVID-19 pandemic highlighted challenges for diagnosis, treatment, and clinical trials and new service delivery models that will continue beyond the pandemic. CONCLUSION APAC-specific prostate cancer research and data are important to ensure that treatment guidelines and recommendations reflect local populations and resources. Facilitated approaches to collaboration across the region such as that achieved through APAC APCCC meetings continue to be a valuable mechanism to ensure the relevance of consensus guidelines within the region.
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Affiliation(s)
- Edmund Chiong
- Department of UrologyNational University Hospital, National University Health SystemSingapore,Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Declan G. Murphy
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
| | | | - Melvin L. K. Chua
- Divisions of Radiation Oncology and Medical SciencesNational Cancer Centre SingaporeSingapore,Oncology Academic ProgrammeDuke‐NUS Medical SchoolSingapore
| | - Lukman Hakim
- Department of Urology, Faculty of MedicineAirlangga University/Airlangga University HospitalSurabayaIndonesia
| | - Agus Rizal Hamid
- Department of UrologyFaculty of Medicine Universitas Indonesia ‐ Cipto Mangunkusumo HospitalJakartaIndonesia
| | - Sung K. Hong
- Department of UrologySeoul National University Bundang HospitalSeongnam‐siKorea
| | - Lisa G. Horvath
- Department of Medical OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Ravi Kanesvaran
- Oncology Academic ProgrammeDuke‐NUS Medical SchoolSingapore,Division of Medical OncologyNational Cancer Centre SingaporeSingapore
| | - Makarand Khochikar
- Department of Uro‐oncologySiddhi Vinayak Ganapati Cancer HospitalMirajIndia
| | - Jason Letran
- Section of UrologyChinese General Hospital and Medical CenterManilaPhilippines
| | - Bannakij Lojanapiwat
- Division of Urology, Department of Surgery, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Rohan Malek
- Department of UrologySelayang HospitalKuala LumpurMalaysia
| | - Anthony C. F. Ng
- SH Ho Urology Centre, Department of SurgeryThe Chinese University of Hong KongHong KongChina
| | | | - See‐Tong Pang
- Department of UrologyChang Gung Memorial Hospital LinkouTaoyuanTaiwan
| | - Darren M. C. Poon
- Department of Clinical OncologyThe Chinese University of Hong KongShatinHong Kong
| | - Teng Aik Ong
- Division of Urology, Department of Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Marniza Saad
- Department of Clinical Oncology, University of Malaya Medical Centre, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Kathryn Schubach
- Men's Health MelbourneMelbourneVictoriaAustralia,Australian and New Zealand Urology Nurses Society (ANZUNS)Australia,ANZUP Cancer Trials GroupSydneyNew South WalesAustralia
| | | | - Levent Türkeri
- Department of UrologyAcıbadem M.A. Aydınlar UniversityIstanbulTurkey
| | - Scott Williams
- Division of Radiation OncologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Alvin Wong
- Department of Haematology OncologyNational University HospitalSingapore
| | - Dingwei Ye
- Department of UrologyShanghai Cancer CenterShanghaiChina
| | | | - Ian D. Davis
- ANZUP Cancer Trials GroupSydneyNew South WalesAustralia,Monash UniversityMelbourneVictoriaAustralia,Eastern HealthMelbourneVictoriaAustralia
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Terada N, Aizawa R, Nihei K, Shiota M, Kojima T, Kimura T, Inoue T, Kitamura H, Sugimoto M, Nishiyama H, Mizowaki T, Kamoto T. Narrative review of local prostate and metastasis-directed radiotherapy in the treatment of metastatic prostate cancer. Jpn J Clin Oncol 2022; 52:633-641. [PMID: 35325157 DOI: 10.1093/jjco/hyac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
The role of local treatment in patients with de novo metastatic prostate cancer is controversial. In population-based retrospective studies, metastatic prostate cancer patients who received local treatment with prostate radiotherapy showed a better prognosis than those who did not. In addition, several prospective randomized studies demonstrated that prostate radiotherapy achieves a survival benefit for patients with oligo-metastasis. Moreover, the efficacy of metastasis-directed radiotherapy was evaluated, revealing a potential benefit for patients with oligo-metastasis. Importantly, these radiotherapies may reduce the occurrence of symptomatic local events. In this review, the rationale, efficacy and future perspectives for local prostate and metastasis-directed radiotherapy in the treatment of metastatic prostate cancer were described and summarized.
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Affiliation(s)
- Naoki Terada
- Department of Urology, Miyazaki University, Miyazaki, Japan
| | - Rihito Aizawa
- Department of Radiation Oncology & Image-Applied Therapy, Kyoto University, Kyoto, Japan
| | - Keiji Nihei
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masaki Shiota
- Department of Urology, Kyushu University, Fukuoka, Japan
| | | | | | | | | | - Mikio Sugimoto
- Department of Urology, Kagawa University, Takamatsu, Japan
| | | | - Takashi Mizowaki
- Department of Radiation Oncology & Image-Applied Therapy, Kyoto University, Kyoto, Japan
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The Impact of 18F-DCFPyL PET-CT Imaging on Initial Staging, Radiation, and Systemic Therapy Treatment Recommendations for Veterans With Aggressive Prostate Cancer. Adv Radiat Oncol 2020; 5:1364-1369. [PMID: 33305100 PMCID: PMC7718503 DOI: 10.1016/j.adro.2020.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/18/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Our purpose was to study the effect of 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) positron emission tomography (PET)-computed tomography (CT) on staging/treatment recommendations of previously untreated prostate cancer. We report here results of a prospective single center single arm imaging trial within Veterans Affairs (Greater Los Angeles): the frequency of patients upstaged to M1 disease (primary endpoint) and the frequency of patients with change in treatment recommendations (secondary endpoint). This is the first report of prostate-specific membrane antigen PET-CT exclusive to U.S. veterans. Methods and Materials Veterans with Gleason ≥4 + 3, clinical stage ≥T2c, or prostate-specific antigen >10 ng/mL were eligible. Patients underwent conventional imaging (99mTc-methyl diphosphonate bone scan or 18F-NaF PET-CT; and pelvic CT or pelvic magnetic resonance imaging) in addition to 18F-DCFPyL PET-CT. The effect of 18F-DCFPyL PET-CT on treatment change was determined by applying prespecified treatment recommendations based on National Comprehensive Cancer Network guidelines and modern clinical practice. Results One hundred patients underwent 18F-DCFPyL PET-CT. Nineteen out of 84 (23%) patients initially thought to be nonmetastatic were upstaged to M1; 8/16 (50%) patients initially thought to have M1 disease were downstaged to M0. In total, 39/100 (39%) had a change in prespecified treatment recommendations, including change of radiation therapy volume/dose in 39/100 (39%) and starting abiraterone in 22/100 (22%). Conclusions Incorporation of 18F-DCFPyL PET-CT into the initial conventional imaging workup for prostate cancer can substantially affect staging/treatment recommendations.
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Devos G, Berghen C, Van Eecke H, Stichele AV, Van Poppel H, Goffin K, Mai C, De Wever L, Albersen M, Everaerts W, De Meerleer G, Joniau S. Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy. Cancers (Basel) 2020; 12:E2271. [PMID: 32823690 PMCID: PMC7464259 DOI: 10.3390/cancers12082271] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/25/2022] Open
Abstract
Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan-Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27-70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58-164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103-132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials.
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Affiliation(s)
- Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven 3000, Belgium; (C.B.); (G.D.M.)
| | - Henri Van Eecke
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
| | - Arthur Vander Stichele
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
| | - Hendrik Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven 3000, Belgium;
| | - Cindy Mai
- Department of Radiology, University Hospitals Leuven, Leuven 3000, Belgium; (L.D.W.); (C.M.)
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven, Leuven 3000, Belgium; (L.D.W.); (C.M.)
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven 3000, Belgium; (C.B.); (G.D.M.)
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium; (H.V.E.); (A.V.S.); (H.V.P.); (M.A.); (W.E.)
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6
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Connor MJ, Shah TT, Horan G, Bevan CL, Winkler M, Ahmed HU. Cytoreductive treatment strategies for de novo metastatic prostate cancer. Nat Rev Clin Oncol 2019; 17:168-182. [PMID: 31712648 DOI: 10.1038/s41571-019-0284-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
In the past decade, a revolution in the treatment of metastatic prostate cancer has occurred with the advent of novel hormonal agents and life-prolonging chemotherapy regimens in combination with standard androgen-deprivation therapy. Notwithstanding, the use of systemic therapy alone can result in a castrate-resistant state; therefore, increasing focus is being placed on the additional survival benefits that could potentially be achieved with local cytoreductive and/or metastasis-directed therapies. Local treatment of the primary tumour with the established modalities of radiotherapy and radical prostatectomy has been explored in this context, and the use of novel minimally invasive ablative therapies has been proposed. In addition, evidence of the potential clinical benefits of metastasis-directed therapy with ionizing radiation (primarily stereotactic ablative radiotherapy) is accumulating. Herein, we summarize the pathobiological rationale for local cytoreduction and the potentially systemic immunological responses to radiotherapy and ablative therapies in patients with metastatic prostate cancer. We also discuss the current evidence base for a cytoreductive strategy, including metastasis-directed therapy, in the current era of sequential multimodal therapy incorporating novel treatments. Finally, we outline further research questions relating to this complex and evolving treatment landscape.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charlotte L Bevan
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Mandel PC, Huland H, Tiebel A, Haese A, Salomon G, Budäus L, Tilki D, Chun F, Heinzer H, Graefen M, Pantel K, Riethdorf S, Steuber T. Enumeration and Changes in Circulating Tumor Cells and Their Prognostic Value in Patients Undergoing Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer-Translational Research Results from the Prospective ProMPT trial. Eur Urol Focus 2019; 7:55-62. [PMID: 31178293 DOI: 10.1016/j.euf.2019.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognostic value of circulating tumor cells (CTCs) in patients with hormone-naïve oligometastatic prostate cancer (HNoMPC) undergoing cytoreductive radical prostatectomy (CRP) is unknown. OBJECTIVE To determine the pre- and postoperative prognostic value of CTC enumeration in patients undergoing CRP. DESIGN, SETTING, AND PARTICIPANTS Thirty-three patients with HNoMPC from the prospective, single-arm ProMPT trial who underwent CRP between 2014 and 2015 at the Martini-Klinik were evaluated. Follow-up visits for all patients were conducted every 6 mo up to 36 mo after CRP and included serial detection of CTCs in 7.5 ml blood samples using the CellSearch system. INTERVENTION CRP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS CTC enumerations before and after CRP, and their prognostic value on metastatic castration-resistant prostate cancer-free survival and overall survival (OS) were analyzed using Kaplan-Meier plots and univariable Cox-regression analysis. RESULTS AND LIMITATIONS Sixteen patients (48.5%) had positive CTCs prior to CRP. A CTC count of ≥2 before or 6 mo after CRP was a prognostic factor for worse oncologic outcome. Compared with other biomarkers (prostate-specific antigen, lactate dehydrogenase, and bone-specific alkaline phosphatase), the prognostic value of CTCs was highest using Harrell's C for OS (0.69), while the highest C-index could be achieved for a combination of conventional markers and CTC count (0.74). After progression to metastatic castration-resistant prostate cancer, CTC enumeration of ≥5 was prognostic for OS. The main limitation is the small sample size. CONCLUSIONS CTC enumeration contributes to prognostic information, which might help select HNoMPC patients who might benefit most from CRP. PATIENT SUMMARY In this report, we looked at the value of circulating tumor cell (CTC) determination in patients undergoing radical prostatectomy for oligometastatic prostate cancer. We could show that the number of CTCs was a prognostic factor at all analyzed time points and was more closely associated with prognosis than other biomarkers commonly used in daily clinical practice.
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Affiliation(s)
- Philipp C Mandel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Tiebel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- Department of Tumour Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Department of Tumour Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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