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45. Gemeinsame Tagung der Österreichischen Gesellschaft für Urologie und Andrologie und der Bayerischen Urologenvereinigung

09.05. - 11.5.2019, Wien, Österreich

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

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  • presenting/speaker Christa Babst - Klinikum rechts der Isar, TUM, Urologie
  • Thomas Amiel - Klinikum rechts der Isar, TUM, Urologie
  • Robert Tauber - Klinikum rechts der Isar, TUM, Urologie
  • Margitta Retz - Klinikum rechts der Isar, TUM, Urologie
  • Jürgen Gschwend - Klinikum rechts der Isar, TUM, Urologie
  • Matthias Heck - Klinikum rechts der Isar, TUM, Urologie

Österreichische Gesellschaft für Urologie und Andrologie. Bayerische Urologenvereinigung. 45. Gemeinsame Tagung der Österreichischen Gesellschaft für Urologie und Andrologie und der Bayerischen Urologenvereinigung. Wien, 09.-11.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc19oegu013

doi: 10.3205/19oegu013, urn:nbn:de:0183-19oegu0137

Published: April 8, 2019

© 2019 Babst et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: Cytoreductive prostatectomy has been proposed as a local treatment option in metastatic prostate cancer in order to prevent local complications and to potentially improve oncological outcome. However, the golden standard in the metastatic setting is systemic treatment. There is a lack of data regarding a cytoreductive radical prostatectomy succeeding neoadjuvant systemic therapy.

Objective: To report the feasibility of a multimodal concept with cytoreductive radical prostatectomy after primary chemohormonal therapy.

Patients and methods: Retrospective, single-institutional analysis of patients with newly diagnosed primary metastatic prostate cancer (M1) treated with chemohormonal therapy (3-monthly LHRH-analogue + 6 cycles 3-weekly docetaxel 75mg/m2) followed by radical prostatectomy and pelvic lymphadenectomy. Only patients with good therapy response were selected for surgery.

We report post-chemohormonal volume reduction of the prostate, histopathologic results and 30-day postoperative complication rate according to Clavien-Dindo.

Results: Between September 2015 and February 2017, 19 patients were treated with radical prostatectomy after chemohormonal therapy. Of these patients, 12 (63%) had low volume disease and 7 (37%) had high volume disease at initial diagnosis according to the CHAARTED trial definition. Overall, 14 (74%) patients had lymph node metastases, 14 (74%) had bone and 3 (16%) had visceral metastases.

Median PSA before and after chemotherapy was 41 ng/ml (range 1–500) and 1.1 ng/ml (range 0–19), respectively. Chemohormonal therapy led to a median prostate volume reduction of 56% from 50cc (range 15–110) before chemo to 22cc (range 7–50) after chemo. Using intraoperative frozen sections, a negative margin could be achieved in 9 patients (47%). After 30 days postoperatively, only one (5%) patient suffered from a severe complication (Grade III), needing a percutaneous nephrostomy because of hydronephrosis.

Conclusion: Cytoreductive radical prostatectomy after chemohormonal therapy with docetaxel is feasible in well-selected patients resulting in a low postoperative complication rate.