a Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany b Martini-Klinik Prostate Cancer Center, Hamburg, Germany
Objective: Cytoreductive radical prostatectomy (cRP) has been proposed as local treatment option in metastatic hormone-sensitive prostate cancer (mHSPC) to prevent local complications and potentially improve oncological outcomes. In this study, we examined the feasibility of a multimodal concept with primary chemohormonal therapy followed by cRP and analyzed prostate size reduction under systemic treatment, postoperative complication rates, as well as early postoperative continence. Methods: In this retrospective study, 38 patients with mHSPC underwent cRP after primary chemohormonal therapy (3-monthly luteinising hormone-releasing hormone-analogue + six cycles 3-weekly docetaxel 75 mg/m2) at two centers between September 2015 and December 2018. Results: Overall, 10 (26%) patients had high volume and 28 (74%) patients had low volume disease at diagnosis, according to CHAARTED definition. Median prostate-specific antigen (PSA) decreased from 65 ng/mL (interquartile range [IQR] 35.0-124.5 ng/mL) pre-chemotherapy to 1 ng/mL (IQR 0.3-1.7 ng/mL) post-chemotherapy. Prostate gland volume was significantly reduced by a median of 50% (IQR 29%-56%) under chemohormonal therapy (p = 0.003). Postoperative histopathology showed seminal vesicle invasion in 33 (87%) patients and negative surgical margins in 17 (45%) patients. Severe complications (Grade 3 according to Clavien-Dindo) were observed in 4 (11%) patients within 30 days. Continence was reached in 87% of patients after 1 month and in 92% of patients after 6 months. Median time to castration-resistance from begin of chemohormonal therapy was 41.1 months and from cRP was 35.9 months. Postoperative PSA-nadir ≤1 ng/mL versus >1 ng/mL was a significant predictor of time to castration-resistance after cRP (median not reached versus 5.3 months; p<0.0001). Conclusion: We observed a reduction of prostate volume under chemohormonal therapy going along with a low postoperative complication and high early continence rate. However, the oncologic benefit from cRP is still under evaluation.
Time from diagnosis to chemotherapy, median (IQR), day
53 (32-74)
Time from diagnosis to surgery, median (IQR), day
250 (222-281)
Time from end of chemotherapy to surgery, median (IQR), day
61 (47-82)
Prostate volume, median (IQR), mL
Pre-docetaxel
50 (35-64)
Pre-surgery
25 (15-31)
Prostate volume reduction, median (IQR), mL
25 (10-35)
Prostate volume reduction, median (IQR), %
50 (29-56)
Hemoglobin, median (IQR), g/dL
Pre-surgery
13.7 (13.0-14.1)
Post-surgery (Day 1 after surgery)
10.7 (10.2-12.1)
Hemoglobin loss, median (IQR), g/dL
2.9 (1.9-3.4)
Operation time, median (IQR), min
196 (157-233)
Hospital length of stay, median (IQR), day
9 (6-10)
Postoperative T stage, n (%)
pT2c
2 (5)
pT3a
3 (8)
pT3b
33 (87)
Postoperative N stage, n (%)
pN0
4 (11)
pN1
34 (89)
Lymph nodes removed, median (IQR), n
18.5 (12-24)
Positive lymph nodes, median (IQR), n
3 (1-6)
Margin status, n (%)
R0
17 (45)
R1
21 (55)
Pad use
Postoperative continence after 1 month (n=31a), n (%)
Postoperative continence after 6 months (n=25b), n (%)
Postoperative continence after 12 months (n=26c), n (%)
0 pad
2 (6)
15 (60)
18 (69)
1 pad (for security)
25 (81)
8 (32)
5 (19)
1 wet pad (mild incontinence)
1 (3)
1 (4)
1 (4)
2 wet pads (moderate incontinence)
3 (10)
1 (4)
2 (8)
≥3 pads (severe incontinence)
0
0
0
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