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Combination Cytoreductive Surgery, Radiotherapy, or Ablation for De Novo Metastatic Prostate Cancer: The IP2-ATLANTA
Martin J Connor1, Taimur T Shah1, Johanna Sukumar2
1Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
European Urology Oncology
|June 14, 2025
Summary
Novel cytoreductive therapies for metastatic hormone-sensitive prostate cancer (mHSPC) are feasible and well-tolerated. Further evaluation is warranted for these advanced prostate cancer treatments.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Metastatic hormone-sensitive prostate cancer (mHSPC) may benefit from cytoreduction of primary tumors, lymph nodes, and metastases.
- Novel cytoreductive therapies are being investigated for improved cancer control in mHSPC.
Purpose of the Study:
- To examine the safety and feasibility of novel cytoreductive therapies in de novo synchronous mHSPC.
- To evaluate minimally invasive ablative therapy (MIAT) and radical treatment combinations.
Main Methods:
- A phase 2, multicentre, three-arm randomised controlled trial (IP2-ATLANTA) was conducted.
- Patients received standard of care, MIAT with pelvic lymph node dissection (PLND) and stereotactic ablative body radiotherapy (SABR), or radical prostatectomy/radiotherapy with PLNRT and SABR.
- Pilot co-primary endpoints included pathological response, randomisation feasibility, and safety.
Main Results:
- 81 patients were randomized, exceeding the target recruitment rate.
- Complete pathological response was observed in 11% of patients.
- Grade 3 or worse adverse events were lower in the MIAT arm (7%) compared to control (18%) and radical arm (15%).
Conclusions:
- Randomisation to combination cytoreductive surgery, radiotherapy, and ablation for mHSPC is feasible.
- These cytoreductive treatment combinations are well-tolerated and warrant further investigation.
- Residual prostate cancer persists in most patients despite systemic therapy.
