TY  - JOUR
A1  - Babst, Christa
A1  - Amiel, Thomas
A1  - Maurer, Tobias
A1  - Knipper, Sophie
A1  - Lunger, Lukas
A1  - Tauber, Robert
A1  - Retz, Margitta
A1  - Herkommer, Kathleen
A1  - Eiber, Matthias
A1  - von Amsberg, Gunhild
A1  - Graefen, Markus
A1  - Gschwend, Juergen
A1  - Steuber, Thomas
A1  - Heck, Matthias
T1  - Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer
T2  - Asian Journal of Urology
N2  - 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.
Y1  - 2022
UR  - https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/124873
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:384-opus4-1248739
SN  - 2214-3882
VL  - 9
IS  - 1
SP  - 69
EP  - 74
PB  - Elsevier BV
CY  - Amsterdam
ER  -