Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer

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/m(2)) 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. (C) 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.

Automated summary

This study examined the feasibility of a multimodal concept with primary chemohormonal therapy followed by cytoreductive radical prostatectomy (cRP) in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). The results showed a significant reduction in prostate volume under chemohormonal therapy, low postoperative complication rates, and high early postoperative continence rates.