A systematic review of cytoreductive prostatectomy outcomes and complications in oligometastatic disease

doi:10.1016/j.ajur.2022.03.017

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Abstract:

Objective: To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.

Methods: We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results.

Results: In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%.

Conclusion: CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.

Key words: Systematic review Prostate cancer Oligometastatic Bone metastases Cytoreductive prostatectomy

收稿日期: 2021-11-23 修回日期: 2022-02-07 接受日期: 2022-03-07 出版日期: 2024-04-20 发布日期: 2024-04-28 整期出版日期: 2024-04-20

引用本文:

. [J]. Asian Journal of Urology, 2024, 11(2): 208-220.
Andrey Morozov, Leonid Chuvalov, Mark Taratkin, Mikhail Enikeev, Leonid Rapoport, Nirmish Singla, Eric Barret, Elena Poddubskaya, Maria Borodina, Georg Salomon, Juan Gomez Rivas, Dmitry Enikeev. A systematic review of cytoreductive prostatectomy outcomes and complications in oligometastatic disease. Asian Journal of Urology, 2024, 11(2): 208-220.

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http://www.ajurology.com/CN/10.1016/j.ajur.2022.03.017 或 http://www.ajurology.com/CN/Y2024/V11/I2/208

Study	Study quality, LE	Imaging modality	Patient, n; age, yr	PSA, ng/mL	Gleason score before treatment^a	Mt characteristic^a	Stage cT^a	Stage pT^a	Complication^a	Functional outcome^a	Oncological outcome
Culp et al., 2014 [34]; retrospective	7, 2b	NR	? RP -245; mean 72 ? BT -129; mean 72 ? NLT -7811; mean 72	? RP^a -<10: 115 (46.9) -10-19: 50 (20.4) -20-29: 17 (6.9) ->30: 32 (13.1) -Unknown: 31 (12.7) ? BT^a -≤19: 64 (49.6) -≥20: 55 (42.6) -Unknown: 10 (7.8) ? NLT^a -<19: 1503 (19.2) -≥20: 5373 (68.8) -Unknown: 935 (12.0)	? RP -7: 51 (20.8) -8: 187 (76.3) -Unknown: 7 (2.9) ? BT -7: 24 (18.6) -8: 94 (72.9) -Unknown: 11 (8.5) ? NLT -7: 439 (5.6) -8: 5673 (72.6) -Unknown: 1699 (21.8)	? RP -M1a: 24 (9.8) -M1b: 150 (61.2) -M1c: 71 (29.0) ? BT -M1a: 16 (12.4) -M1b: 75 (58.1) -M1c: 38 (29.5) ? NLT -M1a: 463 (5.9) -M1b: 5469 (70.0) -M1c: 1879 (24.1)	? RP -≤cT2: 130 (53.1) -≥cT3: 113 (46.1) -Unknown: 2 (0.8) ? BT -≤cT2: 91 (70.5) -≥cT3: 20 (15.5) -Unknown: 18 (14.0) ? NLT -≤cT2: 4318 (55.3) -≥cT3: 1562 (20.0) -Unknown: 1931 (24.7)	NR	NR	NR	? RP -5-yr OS: 67.4% ? BT -5-yr OS: 52.6% ? NLT -5-yr OS: 22.5%
Heidenreich et al., 2015 [32]; case-control	5, 3b	?CT, bone scan, MRI if needed	? RP -23; 61 (42-69)^b ? ADT -38; 64 (47-83)^b	? RP^b ?135.2 (3.5-150.4) ? ADT^b ?105.9 (45-195)	? RP -≤7: 5 (21.7) -8: 7 (30.4) -9: 7 (30.4) -10: 4 (17.4) ? ADT -≤7: 14 (37.8) -8: 11 (29.7) -9: 8 (21.6) -10: 4 (10.8)
Satkunasivam et al., 2015 [30]; retrospective	7, 2c	NR	? RP -47; (73±6)^d ? IMRT: 88; (74.2±6.1)^d ? RT -107; (76.4±6.3)^d ? NLT -3827; (78.2±7.2)^d	? RP^d: 181±263 ? IMRT^d: 282±338 ? RT^d: 531±369 ? NLT^d: 590±380	? RP -≤6: 5 (11) -7: 22 (47) -≥8: 19 (40) -Unknown: 1 (2) ? IMRT -≤6: 10 (11) -7: 24 (27) -≥8: 43 (49) -Unknown: 11 (12) ? RT -≤6: 8 (7) -7: 22 (21) -≥8: 59 (55) -Unknown: 18 (17) ? NLT -≤6: 167 (4) -7: 569 (15) -≥8: 2042 (53) -Unknown: 1049 (27)	? RP -M1a: 3 (7) -M1b: 26 (57) -M1c: 17 (37) ? IMRT -M1a: 3 (7) -M1b: 26 (57) -M1c: 17 (37) ? RT -M1a: 4 (4) -M1b: 72 (67) -M1c: 31 (29) ? NLT -M1a: 190 (5) -M1b: 2570 (70) -M1c: 922 (25)	? RP -≤cT2: 21 (45) -≥cT3: 25 (53) -Unknown: 1 (2) ? IMRT -≤cT2: 63 (72) -≥cT3: 19 (22) -Unknown: 6 (7) ? RT -≤cT2: 59 (55) -≥cT3: 26 (24) -Unknown: 22 (21) ? NLT -≤cT2: 2121 (55) -≥cT3: 759 (20) -Unknown: 947 (25)	NR	NR	NR	? RP -3-yr OS: 73% -3-yr CSS: 79% ? IMRT -3-yr OS: 72% -3-yr CSS: 82% ? RT -3-yr OS: 37% -3-yr CSS: 49% ? NLT -3-yr OS: 34% -3-yr CSS: 46% -Follow-up: median 20 mo
Sooriakumaran et al., 2016 [31]; retrospective	NA, 4	NR	? RP -106; 64.5 (58-70)^e	? RP^e: 23.5 (8.1-55.1)	? RP^e -8.5 (8-9)	-M1a: 36 (34.0) -M1b (≤1 Mts): 20 (18.9) -M1b (2 Mts): 7 (6.6) -M1b (3 Mts): 9 (8.5) -M1b (Mts number not recorded): 34 (32.1)	-≤cT2: 67 (63.2) -≥cT3: 39 (36.8)	-≤pT2: 23 (21.7) -≥pT3: 83 (78.3)	-M1a: 7/36 (19.4) -M1b: 15/70 (21.4) -Total: 22/106 (20.8)	? Incontinence in 3 mo^f -0-1 pad/day: 38 (64.4) -Mild (1-2 pads/d): 10 (16.9) -Severe (≥3 pads/d): 11 (18.6)	? CSM: 11.3% (12 /106) ? PSM: 54.3% (57/105) ? Follow-up: median 22.8 mo
Jang et al., 2018 [23]; retrospective	6, 3b	?CT or MRI, and bone scan	? RARP -38; 65 (62-69)^e ? ADT: 41; 71 (67-76)^e	? RARP^e: 39 (15-84.5) ? ADT^e: 50 (23.8-162.8)	? RARP -≤8: 26 (68.4) -≥9: 12 (31.6) ? ADT -≤8: 24 (58.5) -≥9: 17 (41.5)	-M1a-b: 79 (100)	? RARP: -≤cT2: 5 (13.2) -≥cT3: 33 (86.8) ? ADT: -≤cT2: 2 (4.9) -≥cT3: 39 (95.1)	? RARP: -≤pT2: 2 (5.2) -pT3: 31 (81.6) -pT4: 5 (13.2) ? ADT: NA	? RARP (Clavien-Dindo score): -1: 3 (7.9); -2: 1 (2.6); -3a: 1 (2.6); -3b: 1 (2.6) -Total: 6 (15.7). ? ADT: 11 (26.8)	?NR	? PSM^a: 30 (78.9) ? CRP is a significant predictor of PFS and CSS (PFS: HR 0.388, p=0.003; CSS: HR 0.264, p=0.004) ? Follow-up: median 40 mo
Poelaert et al., 2017 [35]; multicenter prospective	5, 3b	?CT, pelvic MRI, and bone scan	? CRP -17; (64±8)^d ? SoC -29; (72±10)^d	? CRP^b ?16 (4.6-75); ? SoC^b ?156 (5.2-3092)	? CRP -≤7: 4 (24) -8: 5 (29) -≥9: 8 (47) ? SoC -≤7: 2 (6.7) -8: 8 (28) -≥9: 19 (66)
Steuber et al., 2017 [25]; prospective case-control	5, 3b	Bone scan, CT, or MRI	? CRP -43; median 65 ? ADT -40; median 70	? CRP: median 29.0 ? ADT: median 42.5	? CRP -7b: 13 (30.2) -8: 13 (30.2) -9: 15 (34.9) -10: 2 (4.7) ? ADT -≤7a: 1 (2.5) -7b: 5 (12.5) -8: 13 (32.5) -9: 16 (40.0) -10: 5 (12.5)
Leyh-Bannurah et al., 2017 [24]; retrospective	8, 2b	NR	? RP -313; 63 (58-67)^e ? RT -161; 68 (60-73)^e ? NLT -13 218; 72 (63-80)^e	? RP and RT^a,g -≤20: 128 (74) ->20: 46 (26) ? ADT^a -≤20: 864 (17) ->20: 4249 (83)	? RP -6: 41 (13) -7: 105 (34) -8: 145 (46) -Unknown: 22 (7) ? RT -6: 30 (19) -7: 47 (29) -8: 72 (45) -Unknown: 12 (7.5)	? RP -M1a: 35 (11) -M1b: 222 (71) -M1c: 56 (18) ? RT -M1a: 19 (12) -M1b: 103 (64) -M1c: 39 (24) ? ADT -M1a: 800 (6) -M1b: 9478 (72) -M1c: 2940 (22)	? RP -≤cT2: 280 (89.5) -≥cT3: 33 (10.5) ? RT: -≤cT2: 137 (86.1) -≥cT3: 24 (14.9) ? ADT -≤cT2: 10597 (80.2) -≥cT3: 2621 (19.8)	NR	NR	NR	? RP and RT (n=474): lower CSM (HR=0.40, 95% CI 0.32-0.50) vs. NLT (n=1896)^h ? RP (n=161): lower CSM (HR=0.59, 95% CI 0.35-0.99) vs. RT (n=161)
Kim et al., 2018 [29]; retrospective, cohort, multicenter	7, 2c	NR	? CRP (metastatic PCa) -68; 64.3 (33-80)^c ? RP ( localized PCa) -598; 63.5 (39-82)^c	? CRP: 10.10 (0.01-352.00)^c ? RP: 6.50 (0.12-104.00)^c	? CRPⁱ -≤7: 25 (37.9) -8: 19 (28.8) -9: 20 (30.3) -10: 2 (3.0) ? RPⁱ -≤7: 471 (80.1) -8: 73 (12.4) -9: 39 (6.6) -10: 5 (0.9)	? CRPⁱ -M1: 23 (33.8) -N1: 45 (66.2) -N1M0: 45 (66.2) -N0M1: 20 (29.4) -N1M1: 3 (4.4) ? RP: NA	? CRPⁱ -cT2: 17 (25) -cT3: 42 (61.8) -cT4: 9 (13.2) ? RPⁱ -cT2: 525 (88.7) -cT3: 62 (10.5) -cT4: 5 (0.8)	? CRPⁱ ?≤pT2: 15 (23.4) ?pT3: 39 (60.9) ?pT4: 10 (15.6) ? RPⁱ ≤pT2: 396 (66.9) pT3: 187 (31.6) ?pT4: 9 (1.5)	? CRP (Clavien-Dindo score) -0: 62 (91.2) -1: 2 (2.9) -2: 1 (1.5) -3а: 0 -3b: 3 (4.4) -4≥: 0 -Total: 6 (8.8) ? RP (Clavien-Dindo score) -0: 563 (94.2) -1: 19 (3.2) -2: 3 (0.5) -3а: 5 (0.8) -3b: 6 (1) -4а: 2 (0.3) -4b≥: 0 -Total: 35 (5.9)	? CRP -Urinary continence significantly lower (57.4% vs. 90.8%, p<0.0001)	? CRP -PSM^a: 43 (63.2) ? RP -PSM^a: 112 (19)
Heidenreich et al., 2018 [33]; retrospective, multicenter	NA, 4	?CT, bone scan, or MRI if needed	? RP -113; 60.2 (42-69)^e	? 34.2 (0.1-357.4)^c	? RP -6: 4 (3.5) -7: 18 (15.9) -8: 42 (37.2) -9: 40 (35.4) -10: 9 (7.9)	? Low volume (≤3 Mts) -88 (77.9) ? High volume (≥4 Mts) -25 (22.1)	NR	-pT2: 21 (18.6) -pT3a/b: 76 (67.3) -pT4a: 16 (14.2)	? Clavien-Dindo score -1: 13 (11.5) -2: 14 (12.4) -3a: 5 (4.4) -3b: 6 (5.3) -4-5: 0 -Total: 38 (33.6)	? Incontinence within 12 mo -No: 77 (68.1) -Mild (1-2 pads/day): 20 (17.7) -Severe (>2 pads/day): 16 (14.2)	? 3-yr OS: 87.6% ? 5-yr OS: 79.6% ? CRFS: 72.3 mo ? Symptomatic local relapse: 0 ? BRFS: -PSA <8.0 ng/mL: 78% -PSA >8.0 ng/mL: 32% ? PSM^a: 42 (37.2) ? Follow-up^c: 53.6 (13-96) mo
Lan et al., 2019 [27]; retrospective	6, 3b	CT, bone scan, or MRI if needed	? CRP -35; (67.8±7.2)^d ? ADT -76; (71.2±7.7)^d	? CRP^d: ?90.4±152.8 ? ADT^d: ?502.9±806	? CRP -≤7: 27 (77.2) -8: 6 (17.1) -≥9: 2 (5.7) ? ADT -≤7: 27 (34.6) -8: 27 (34.6) -≥9: 23 (29.5) -Unknown: 1 (1.3)	? Bone Mts (≤5 Mts) -М1b: 111 (100) -Excluded: visceral metastases	? CRP -≤cT2: 24 (68.6) -≥cT3: 8 (22.9) -Unknown: 3 (8.6) ? ADT -≤cT2: 14 (18.4) -≥cT3: 32 (42.1) -Unknown: 30 (39.5)	? CRP -pT2: 15 (42.9) -pT3: 16 (45.7) -pT4: 4 (11.4) ? ADT: NA	NR	NR	? CRP -3-yr PFS: 42.7% -5-yr PFS: 19% -3-yr CSS: 90.8% -5-yr CSS: 63.6% -CSM^a: 4 (11.4) -PSM^a: 10 (28.6) -CPFS^e: 35 (10-49) mo -Follow-up: mean 36.9 mo ? ADT -3-yr PFS: 27% -5-yr PFS: 21% -3-yr CSS: 87.9% -5-yr CSS: 74.9% -CSM: 11 (14.5%) -PFS^e: 21 (10-49) mo; -Follow-up: mean 39.2 mo
Yuh et al., 2019 [26]; prospective	NA, 4	Bone scan, CT, or MRI	? RP -32; 64 (50-73)^b	? 75.5 (5-418)^c	-≤7: 11 (34.4) -8: 20 (62.5) -Not available result: 1 (3.1)	-N1M0: 7 (21.9) -N1M1a: 3 (9.4) -N1M1b: 7 (21.9) -N0M1a: 0 -N0M1b: 15 (46.9)	-cT1: 6 (18.8) -cT2: 13 (40.6) -cT3: 13 (40.6)	-pT2: 6 (18.8) -pT3a: 6 (18.8) -pT3b: 20 (62.5)	? Clavien-Dindo score -1: 5 (15.6) -2: 3 (9.3) -3: 0 -4: 1 (3.1) -5: 1 (3.1) -Total: 10 (31.3)	? Incontinence within 6 mo -No: 16 (50) ? Mean score decreased from 11.5 preoperatively to 4.7 following surgery (p= 0.0018)	? PSM^a: 21 (65.6%)
Simforoosh et al., 2019 [28]; prospective	7, 3b	CT, MRI, bone scan, or PET-PSMA if needed	? CRP -26; (61.5±7.7)^d ? NLT -23; (64.6±6.2)^d	? CRP^d: 108±73 ? NLT^d: 84±61	? CRP -≤7: 1 (3.8) -8: 2 (7.6) -9: 18 (69.2) -10: 5 (19.2) ? NLT: NR	? CRP -Low volume bone (≤5 Mts): 10 (38.5) -High volume (≥6 Mts): 16 (61.5) ? NLT -Low volume bone (≤5 Mts): 9 (39.1) -High volume (≥6 Mts): 14 (60.9)	NR	? RP -pT2b: 1 (3.8) -pT2c: 1 (3.8) -pT3a: 1 (3.8) -pT3b: 22 (84.6) -pT4: 1 (3.8) ? NLT: NA	? CRP (Clavien-Dindo score) -1-3: 7 (26.9) ? NLT: 9 (38.9) patients required intervention	? CRP ( incontinence)^j -No: 22 (84.6) -Stress: 3 (11.5)	? CRP -CSM^a: 6 (23.1) -BR^a: 9 (34.6) -PSM^a: 26 (100) -Follow-up: median 19.2 mo ? NLT -CSM^a: 8 (34.8) -BR^a: 17 (73.9) -Follow-up: median 22.8 mo
Knipper et al., 2020 [36]; retrospective	6, 2c	Bone scan, CT, or MRI	? RP -78; 64 (59-69)^e ? RT -410; 68 (63-73)^e, from STAMPEDE arm H (low metastatic burden)	? RP: 35 (13-55)^e ? RT: 55 (23-138)^e	? RP -7: 18 (23) -8-9: 60 (77) ? RT -7: 84 (20) -8-9: 308 (75) -Unknown: 18 (4)	? RP -M1b: 78 (100) ? RT -M1a: 82 (20) -M1b: 311 (76) -M1c: 17 (4)	? RP -≤cT2: 58 (74) -≥cT3: 16 (21) -Tx: 4 (5) ? RT -≤cT2: 39 (10) -≥cT3: 355 (87) -Tx: 16 (4)	? RP -pT2: 6 (8) -pT3: 67 (86) -pT4: 5 (6). ? RT: NA	? RP (Clavien-Dindo score) -1: 6 (8) -2: 12 (15) -3a: 6 (8) -3b: 8 (10) -4: 2 (3) -Total^k: 34 (43.6)	? RP (continence at 1-yr follow-up) -0-1 pad/day): 28 (36) -1 pad/day): 10 (13) -Unknown: 40 (51)	? RP (3-yr follow-up) -OS: 91% -PFS: 63% -MPFS: 63% -CSS: 92% ? RT (3-yr follow-up) -OS: 81% -PFS: 63% -MPFS: 67% -CSS: 86%

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