Multi-institutional Analysis of Metastasis-directed Therapy with or Without Androgen Deprivation Therapy in Oligometastatic Castration-sensitive Prostate Cancer
- Author(s)
- Deek, MP; Sutera, P; Jing, Y; Gao, R; Rothman, E; Day, H; Chang, D; Dirix, P; Armstrong, AJ; Campbell, B; Campos, FL; Berenguer, M; Ramotar, M; Conde-Moreno, A; Berlin, A; Bosetti, DG; Corcoran, N; Koontz, B; Mercier, C; Siva, S; Pryor, D; Ost, P; Huynh, MA; Kroeze, S; Stish, B; Kiess, A; Trock, B; Tran, PT; Gillessen, S; Sweeney, C;
- Journal Title
- European Urology Oncology
- Publication Type
- Online publication before print
- Abstract
- BACKGROUND: Metastasis-directed therapy (MDT) is increasingly being used in oligometastatic castration-sensitive prostate cancer (omCSPC). However, it is currently unclear how to optimally integrate MDT with the standard of care of systemic hormonal therapy. OBJECTIVE: To report long-term outcomes of MDT alone versus MDT and a defined course of androgen deprivation therapy (ADT) in omCSPC. DESIGN, SETTING, AND PARTICIPANTS: Here, a multicenter, international retrospective cohort of omCSPC as defined by conventional imaging was reported. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Biochemical progression-free survival (bPFS), distant progression-free survival (dPFS), and combined biochemical or distant progression-free survival (cPFS) were evaluated with Kaplan-Meier and multivariable Cox proportional hazard regression models. RESULTS AND LIMITATIONS: A total of 263 patients were included, 105 with MDT + ADT and 158 with MDT alone. The majority of patients had metachronous disease (90.5%). Five-year bPFS, dPFS, and cPFS were, respectively, 24%, 41%, and 19% in patients treated with MDT + ADT and 11% (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.64), 29% (HR 0.56, 95% CI 0.40-0.78), and 9% (HR 0.50, 95% CI 0.38-0.67) in patients treated with MDT alone. On a multivariable analysis adjusting for pretreatment variables, the use of ADT was associated with improved bPFS (HR 0.43, p < 0.001), dPFS (HR 0.45, p = 0.002), and cPFS (HR 0.44, p < 0.001). CONCLUSIONS: In this large multi-institutional report, the addition of concurrent ADT to MDT appears to improve time to prostate-specific antigen progression and distant recurrence, noting that about 10% patients had durable control with MDT alone. Ongoing phase 3 studies will help further define treatment options for omCSPC. PATIENT SUMMARY: Here, we report a large retrospective review evaluating the outcomes of metastasis-directed therapy with or without a limited course of androgen deprivation for patients with oligometastatic castration-sensitive prostate cancer. This international multi-institutional review demonstrates that the addition of androgen deprivation therapy to metastasis-directed therapy (MDT) improves progression-free survival. While a proportion of patients appear to have long-term disease control with MDT alone, further work in biomarker discovery is required to better identify which patients would be appropriate for de-escalated therapy.
- Keywords
- Androgen deprivation therapy; Castration-sensitive prostate cancer; Metastasis-directed therapy; Oligometastatic
- Department(s)
- Radiation Oncology
- Publisher's Version
- https://doi.org/10.1016/j.euo.2024.03.010
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-07-04 04:37:42
Last Modified: 2024-07-04 04:49:35