Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland.
Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Eur Urol Oncol. 2024 Aug;7(4):721-734. doi: 10.1016/j.euo.2023.09.006. Epub 2023 Oct 14.
De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown.
To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET.
DESIGN, SETTING, AND PARTICIPANTS: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET.
Cytoreductive radical prostatectomy.
Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed.
Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up.
Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy.
We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.
前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）上的新发性寡转移前列腺癌（omPCa）是一种新的疾病实体，其最佳治疗方法尚不清楚。
分析在 PSMA-PET 上接受去势治疗性根治性前列腺切除术（cRP）治疗的 omPCa 患者的结果。
设计、地点和参与者：总体而言，在 13 个欧洲中心确定了 116 名接受 cRP 治疗的患者。寡转移前列腺癌的定义为 PSMA-PET 上有五个或更少的骨转移和/或 miM1c 中有三个或更少的肺病变的 miM1a 和/或 miM1b，以及 miM1c。
去势治疗性根治性前列腺切除术。
根据 Clavien-Dindo 分析了 30 天并发症、控尿率、去势抵抗性前列腺癌（CRPC）发生时间和总生存（OS）。
总体而言，95（82%）例患者有 miM1b，18（16%）例患者有 miM1a，3（2.6%）例患者有 miM1c omPCa。活检前前列腺特异性抗原中位值为 14ng/ml，102（88%）例患者活检分级≥3 级前列腺癌。PSMA-PET 上转移灶的中位数为 2 个；38（33%）、29（25%）和 49（42%）例患者有一个、两个和三个或更多远处阳性病变。共有 70（60%）名男性接受了新辅助全身治疗，37（32%）名男性接受了转移导向治疗。分别有 36（31%）和 6（5%）例患者发生任何和 Clavien-Dindo 分级≥3 的并发症。在中位随访 27 个月时，19（16%）例患者发生 CRPC，8（7%）例患者死亡。1 年尿控率为 82%。2 年 CRPC 无进展生存率和 OS 分别为 85.8%（95%置信区间[CI]78.5-93.7%）和 98.9%（95% CI 96.8-100%）。局限性包括回顾性设计和短期随访。
在 PSMA-PET 上患有新发性寡转移前列腺癌的患者中，去势治疗性根治性前列腺切除术是一种安全可行的治疗选择。尽管总体上具有良好的肿瘤学结果，但这些患者中的一些具有不可忽视的早期进展风险，因此应考虑采用多模式治疗。
我们发现，在专家中心接受手术治疗局限性前列腺癌且使用新型分子成像技术检测到少量转移的患者，具有良好的短期生存、功能结果和可接受的并发症发生率。
