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Metastasis-directed therapy prolongs efficacy of systemic therapy and improves clinical outcomes in oligoprogressive castration-resistant prostate cancer

  • Matthew P. Deek,
  • Kekoa Taparra,
  • Ryan Phillips,
  • Pedro Isaacsson Velho,
  • Robert W. Gao,
  • Curtiland Deville,
  • Daniel Y. Song,
  • Stephen Greco,
  • Michael Carducci,
  • Mario Eisenberger,
  • Theodore L. DeWeese,
  • Samuel Denmeade,
  • Kenneth Pienta,
  • Channing J. Paller,
  • Emmanuel S. Antonarakis,
  • Kenneth R. Olivier,
  • Sean S. Park,
  • Phuoc T. Tran,
  • Bradley J. Stish

Publication: European Urology Oncology, June 2020

Background

Available therapies for castrate-resistant prostate cancer (CRPC) confer minimal survival advantage; thus, there is interest in metastasis-directed therapy (MDT) for oligometastatic or oligoprogressive disease to improve outcomes. Here, we describe outcomes of oligoprogressive CRPC treated with stereotactic ablative radiotherapy (SABR).

Objective

To report outcomes of oligoprogressive CRPC treated with MDT using SABR.

Design, setting, and participants

Patients with oligoprogressive CRPC were retrospectively evaluated, and outcomes following MDT were reported. Outcomes were additionally compared with oligoprogressive CRPC treated with change in systemic therapy alone.

Intervention

SABR to oligoprogressive lesions.

Outcome measurements and statistical analysis

Outcomes of interest were time to prostate-specific antigen (PSA) failure, time to next intervention (TTNI), distant metastasis-free survival (DMFS), and overall survival. Survival analysis was performed using the Kaplan-Meier method, and univariable analysis and multivariable analysis (MVA) were performed.

Results and limitations

A total of 68 patients were included. After MDT, median time to PSA recurrence, TTNI, and DMFS were 9.7, 15.6, and 10.8 months, respectively. A total of 112 lesions were treated, and the cumulative incidences of local failure at 12 and 24 months were 2.1% and 13.8%, respectively. Factors associated with the risk of local recurrence on univariable analysis were age (hazard ratio [HR] 1.07, p = 0.03) and Gleason grade group (HR 2.20, p = 0.07). Compared with change in systemic therapy alone (n = 52), MDT (n = 31) was associated with improved median time to PSA failure (9.7 vs 4.2 months, p = 0.066)), TTNI (14.9 vs 8.8 months, p = 0.025), and DMFS (12.7 vs 8.9 months, p = 0.045), and remained associated with improved outcomes on MVA.

Conclusions

In a retrospective cohort of oligoprogressive CRPC patients, MDT was associated with favorable outcomes and improved cancer control as compared with change in systemic treatment alone. Future prospective trials are needed to confirm these findings.