Study shows benefits of metastasis-directed therapy without ADT for oligorecurrent prostate cancer

Study shows benefits of metastasis-directed therapy without ADT for oligorecurrent prostate cancer

In patients with solitary metastases of prostate cancer, an approach called metastasis-directed therapy (MDT)—targeted treatment through surgery or radiation therapy without androgen deprivation therapy (ADT)—can slow the time to cancer progression, reports a study in The Journal of Urology®, an official journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio of Wolters Kluwer.

Metastatic-directed therapy has been a controversial approach to treat sole metastatic recurrences of prostate cancer. Our study is the first to demonstrate the benefits of both surgical and radiotherapy MDT without ADT in this patient population, potentially delaying the need for systemic treatment.”

Jack R. Andrews, MD, lead author, Mayo Clinic Arizona, Phoenix

MDT as a potential alternative target in the area of ​​cancer spread

Metastatic-directed treatment has emerged as a potential alternative for men with “oligorecurrent” prostate cancer – a disease condition with a limited number of metastatic lesions after initial treatment. The MDT approach uses surgery or radiation therapy (steretotactic body radiotherapy or SBRT) to specifically target the area of ​​cancer spread.

This is in contrast to ADT, a systemic therapy designed to block testosterone and other male sex hormones that promote the growth of prostate cancer. Androgen deprivation therapy with or without other systemic therapy is the standard treatment for metastatic prostate cancer, but has numerous side effects that can affect quality of life - including, but not limited to, sexual dysfunction, bone loss, and loss of muscle strength. If MDT is effective in controlling limited recurrences, it may avoid or delay the need for ADT.

Dr. Andrews and colleagues evaluated their center's experience with MDT without ADT in 124 patients with oligorecurrent prostate cancer between 2008 and 2018. Treatment consisted of surgery in 67 patients, most with lymph node metastases; and radiation in 57 patients, most patients with bone metastases. In both groups, the average follow-up time was approximately four and a half years.

Promising results with MDT in oligorecurrent prostate cancer

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Both forms of MDT were effective in terms of biochemical recurrence, as reflected by a reduction in prostate-specific antigen (PSA). After surgery, PSA decreased by about half in 80.5% of patients after MDT. Most patients eventually required ADT or other systemic therapy for progressive cancer – median time 18.5 months. However, after three years of follow-up, 29% of patients were alive and free of cancer progression.

In the radiotherapy group, 40.3% of patients had their PSA value halved. The median time to systemic therapy was 17%, while the 3-year progression-free survival was 17%. The researchers emphasize that their study was not designed to compare the results of surgery and radiation because the two types of MDT were used in patients with different types of cancer metastases (lymph node versus bone).

“The role of MDT in prostate cancer remains highly controversial, with insufficient evidence to support recommendations in current guidelines,” write Drs. Andrews and co-authors. They point out some important limitations to their study - including selection bias related to the fact that patients who chose MDT were likely a "healthier, more robust" group seeking a more aggressive treatment option.

“These results suggest that MDT without ADT may delay initiation of systemic therapy in men with oligorecurrent prostate cancer,” conclude Dr. Andrews and colleagues. They call for further studies to determine which patients with single metastases may benefit most from MDT.

Source:

Wolters Klüwer

Reference:

Andrews, JR, et al. (2022) Metastasis-targeted therapy without androgen deprivation therapy for solitary oligorecurrent prostate cancer. Journal of Urology. doi.org/10.1097/JU.0000000000002898.

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