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Minerva Urologica e Nefrologica 2020 October;72(5):531-42

DOI: 10.23736/S0393-2249.20.03779-0


lingua: Inglese

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, Erasme Hospital, University Clinics of Brussels, University of Brussels, Brussels, Belgium; 10 Department of Urology, Campus Bio-Medico University, 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

INTRODUCTION: The aim of this review was 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”) 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 randomized 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 randomized 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 randomized 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: Prostatic neoplasms; Neoplasm metastasis; Molecular targeted therapy

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