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Minerva Urologica e Nefrologica 2020 Jun 16

DOI: 10.23736/S0393-2249.20.03779-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Metastasis-directed therapy and prostate-targeted therapy in oligometastatic prostate cancer: a systematic review

Noriyoshi MIURA 1, 2 , Benjamin PRADERE 1, 3, 4, Keiichiro MORI 1, 5, Hadi MOSTAFAEI 1, 6, Fahad QUHAL 1, 7, Vincent MISRAI 8, David D’ANDREA 1, Simone ALBISINNI 9, Rocco PAPALIA 10, Takashi SAIKA 2, Roberto M. SCARPA 10, Shahrokh F. SHARIAT 1, 11, 12, 13, 14, 15, 16, 17, Francesco ESPERTO 4, 10, 11, 18

1 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; 2 Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan; 3 Department of Urology, University Hospital of Tours, Tours, France; 4 EAU Young Urologist Office (YOU), Arnhem, the Netherlands; 5 Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; 6 Research Center for Evidence based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 7 Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia; 8 Department of Urology, Clinique Pasteur, Toulouse, France; 9 Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; 10 Department of Urology, Campus Biomedico University of Rome, Rome, Italy; 11 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 12 Department of Urology, Weill Cornell Medical College, New York, NY, USA; 13 Department of Urology, University of Texas Southwestern, Dallas, TX, USA; 14 Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; 15 Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; 16 Department of Urology, University of Jordan, Amman, Jordan; 17 European Association of Urology Research Foundation, Arnhem, the Netherlands; 18 European Society of Residents in Urology (ESRU), Arnhem, the Netherlands


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INTRODUCTION: This review aims to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa).
EVIDENCE ACQUISITION: We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: (prostate cancer OR prostate carcinoma OR prostate neoplasm OR prostate tumor OR prostate tumour) AND (oligometastatic OR oligometastasis OR PSMA) AND (surgery OR prostatectomy OR radical prostatectomy OR cytoreductive OR local treatment OR radiotherapy OR stereotactic OR stereotaxic) AND (survival OR mortality).
EVIDENCE SYNTHESIS: After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomised studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomised controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomised phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear.
CONCLUSIONS: We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.


KEY WORDS: Prostate cancer; Oligometastatic; metastasis-directed therapy; Prostate-targeted therapy

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