Multidisciplinary Therapy in Men with Newly Diagnosed Oligometastatic Prostate Cancer

• Main Authors: Watanabe K, Kawaguchi G, Ikeda Y, Hara N, Nishiyama T
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-08-01
• Series: Research and Reports in Urology
• Subjects: prostate cancer; oligometastases; multidisciplinary therapy
• Online Access: https://www.dovepress.com/multidisciplinary-therapy-in-men-with-newly-diagnosed-oligometastatic--peer-reviewed-fulltext-article-RRU

Kazuhiro Watanabe,1,* Gen Kawaguchi,2,* Yohei Ikeda,3 Noboru Hara,1 Tsutomu Nishiyama1 1Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan; 2Department of Radiotherapy, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan; 3Department of Diagnostic Radiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan*These authors contributed equally to this workCorrespondence: Tsutomu NishiyamaDepartment of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Urasa 4132, Minamiuonuma, Niigata, 949-7302, JapanTel [phone]Fax [phone]Email [e-mail]: To assess the use of aggressive local therapy with systemic therapy for patients with oligometastatic prostate cancer.Patients and Methods: Patients with oligometastatic prostate cancer received systemic therapy centered on androgen deprivation therapy (ADT). After six months or more of ADT, the patients received radiation therapy or surgery for the prostate, and radiation therapy for all metastatic sites. ADT was continued for 2– 3 years after local therapy.Results: Twelve patients who were judged to be able to undergo radiotherapy or surgical treatment of the prostate and radiation therapy for all metastatic sites and one case of pubic bone recurrence after radical prostatectomy were included. Bone metastases (n = 11) and para-aortic lymph node metastases (n = 2) were found. The number of bone metastases was one (n = 7), two (n = 3), and three (n = 1). Radiation therapy (70– 74 Gy) was performed on the prostate in 11 of 12 patients. A prostatectomy was performed on one patient who was judged to be unable to receive a sufficient dose to the metastatic site when radical radiation was applied to the prostate. Radiation therapy (45– 60 Gy) was performed on all metastatic sites. Prostate-specific antigen (PSA) levels increased again during treatment in three patients. There was a significant difference in PSA levels before local therapies between the three patients who developed castration-resistant prostate cancer (CRPC) during the course of treatment and the eight patients who did not progress to CRPC (p = 0.012). There was also a significant difference in PSA levels after local therapies between the three patients who developed CRPC during the course of treatment and the eight patients who did not progress to CRPC (p = 0.012). Four patients completed treatment. In one patient in whom the testosterone level recovered to the normal level the PSA level remained the level below the measurement sensitivity.Conclusion: Aggressive local therapy in combination with systemic therapy centered on ADT is a promising treatment option for oligometastatic prostate cancer.Keywords: prostate cancer, oligometastases, multidisciplinary therapy