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

作     者：Christa Babst Thomas Amiel Tobias Maurer Sophie Knipper Lukas Lunger Robert Tauber Margitta Retz Kathleen Herkommer Matthias Eiber Gunhild von Amsbergb Markus Graefen Juergen Gschwend Thomas Steuber Matthias Heck Christa Babst;Thomas Amiel;Tobias Maurer;Sophie Knipper;Lukas Lunger;Robert Tauber;Margitta Retz;Kathleen Herkommer;Matthias Eiber;Gunhild von Amsberg;Markus Graefen;Juergen Gschwend;Thomas Steuber;Matthias Heck

作者机构：Department of UrologyTechnical University of MunichRechts der Isar Medical CenterMunichGermany Martini-Klinik Prostate Cancer CenterHamburgGermany 

出 版 物：《Asian Journal of Urology》 (亚洲泌尿外科杂志（英文）)

年 卷 期：2022年第9卷第1期

页      面：69-74页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Metastatic hormone-sensitive prostate cancer Chemohormonal therapy Cytoreductive radical prostatectomy Feasibility Prevent local complications Continence rate 

摘      要：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 *** 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 ***: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 ***:Overall,10(26%)patients had high volume and 28(74%)patients had low volume disease at diagnosis,according to CHAARTED *** 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)*** 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%)*** complications(Grade 3 according to Clavien-Dindo)were observed in 4(11%)patients within 30 *** was reached in 87%of patients after 1 month and in 92%of patients after 6 *** time to castration-resistance from begin of chemohormonal therapy was 41.1 months and from cRP was 35.9 *** PSA-nadir≤1 ng/mL versus1 ng/mL was a significant predictor of time to castration-resistance after cRP(median not reached versus 5.3 months;p0.0001).Conclusion:We observed a reduction of prostate volume under chemohormonal therapy going along with a low postoperative complication and high early continence ***,the oncologic benefit from cRP is still under evaluation.