Upfront metastasis-directed therapy in oligorecurrent prostate cancer does not decrease the time from initiation of...

Area of Science:

• Oncology
• Urology
• Radiology

Background:

• Oligorecurrent castration-sensitive prostate cancer (PC) presents a unique clinical challenge.
• Metastases-directed therapy (MDT) is being explored as a strategy to prolong the castration-sensitive phase.
• Understanding the efficacy of upfront MDT is crucial for treatment planning.

Purpose of the Study:

• To investigate the impact of upfront metastases-directed therapy (MDT) on prolonging the castration-sensitive phase in patients with oligorecurrent castration-sensitive prostate cancer (PC).
• To evaluate the time to castration resistance (TTCR) as the primary endpoint.
• To assess secondary endpoints including ADT-free survival, local progression-free survival, and overall survival.

Main Methods:

• A multicenter retrospective study analyzing 82 patients with castrate-sensitive oligorecurrent PC.
• Oligorecurrent PC defined as 1-3 non-visceral lesions (bone or nodes) detected by 18F-Choline PET/CT or 68-Gallium PSMA PET/CT.
• Primary endpoint: time to castration resistance; Secondary endpoints: ADT-free survival, local progression-free survival, overall survival.

Main Results:

• The median time to castration resistance for the entire cohort was 49 months.
• 1- and 2-year TTCR-free survival rates were 94% and 82%, respectively.
• Upfront MDT did not decrease the time from initiation of androgen deprivation therapy (ADT) to castration resistance.

Conclusions:

• In this cohort, upfront MDT did not demonstrate a benefit in prolonging the castration-sensitive phase for patients with oligorecurrent castration-sensitive prostate cancer.
• The findings suggest that MDT may not alter the natural course of disease progression in terms of time to castration resistance.
• Further research may be needed to identify patient subgroups who could benefit from MDT in this setting.