Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study

Pawel Rajwa; Daniele Robesti; Michael Chaloupka; EAU-YAU Prostate Cancer Working Party (PCa-WP); Fabio Zattoni; Alexander Giesen; Nicolai A Huebner; Aleksandra Krzywon; Marcin Miszczyk; Matthias Moll; Rafał Stando; Edoardo Cisero; Sofiya Semko; Enrico Checcucci; Gaëtan Devos; Maria Apfelbeck; Cecilia Gatti; Giancarlo Marra; Roderick C N van den Bergh; Gregor Goldner; Sazan Rasul; Francesco Ceci; Fabrizio Dal Moro; Francesco Porpiglia; Paolo Gontero; Anders Bjartell; Christian Stief; Axel Heidenreich; Steven Joniau; Alberto Briganti; Shahrokh F Shariat; Giorgio Gandaglia

doi:10.1016/j.euo.2023.09.006

Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study

Pawel Rajwa
, Daniele Robesti
, Michael Chaloupka
, EAU-YAU Prostate Cancer Working Party (PCa-WP)
, Fabio Zattoni
, Alexander Giesen
, Nicolai A Huebner
, Aleksandra Krzywon
, Marcin Miszczyk
, Matthias Moll
, Rafał Stando
, Edoardo Cisero
, Sofiya Semko
, Enrico Checcucci
, Gaëtan Devos
, Maria Apfelbeck
, Cecilia Gatti
, Giancarlo Marra
, Roderick C N van den Bergh
, Gregor Goldner

Sazan Rasul, Francesco Ceci, Fabrizio Dal Moro, Francesco Porpiglia, Paolo Gontero, Anders Bjartell, Christian Stief, Axel Heidenreich, Steven Joniau, Alberto Briganti, Shahrokh F Shariat, Giorgio Gandaglia

Medical University of Vienna
Vita-Salute San Raffaele University
Ludwig Maximilian University of Munich
University of Padua
University Hospitals Leuven
Maria Sklodowska-Curie Memorial National Research Institute of Oncology
Holy Cross Cancer Center
University of Turin
University of Cologne
IRCCS Fondazione del Piemonte per l'Oncologia - Candiolo (TO)
St. Antonius Ziekenhuis
IEO - European Institute of Oncology IRCCS
Lund University (Malmö)
Charles University

Research output: Contribution to journal › Article › Academic › peer-review

20 Citations (Scopus)

19 Downloads (Pure)

Abstract

BACKGROUND: De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown.

OBJECTIVE: To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET.

DESIGN, SETTING, AND PARTICIPANTS: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET.

INTERVENTION: Cytoreductive radical prostatectomy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed.

RESULTS AND LIMITATIONS: Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up.

CONCLUSIONS: Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy.

PATIENT SUMMARY: We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.

Original language	English
Pages (from-to)	721-734
Number of pages	14
Journal	European urology oncology
Volume	7
Issue number	4
Early online date	14 Oct 2023
DOIs	https://doi.org/10.1016/j.euo.2023.09.006
Publication status	Published - 1 Aug 2024
Externally published	Yes

Bibliographical note

Publisher Copyright:
Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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1-s2.0-S2588931123001979-mainFinal published version, 2.27 MBLicence: CC BY

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Rajwa, P., Robesti, D., Chaloupka, M., EAU-YAU Prostate Cancer Working Party (PCa-WP), Zattoni, F., Giesen, A., Huebner, N. A., Krzywon, A., Miszczyk, M., Moll, M., Stando, R., Cisero, E., Semko, S., Checcucci, E., Devos, G., Apfelbeck, M., Gatti, C., Marra, G., van den Bergh, R. C. N., ... Gandaglia, G. (2024). Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study. European urology oncology, 7(4), 721-734. https://doi.org/10.1016/j.euo.2023.09.006

@article{c0651a43e9854d5bb3f69ea92de86c95,

title = "Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study",

abstract = "BACKGROUND: De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown.OBJECTIVE: To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET.DESIGN, SETTING, AND PARTICIPANTS: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET.INTERVENTION: Cytoreductive radical prostatectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed.RESULTS AND LIMITATIONS: Overall, 95 (82\%) patients had miM1b, 18 (16\%) miM1a, and three (2.6\%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88\%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33\%), 29 (25\%), and 49 (42\%) patients had one, two, and three or more distant positive lesions. A total of 70 (60\%) men received neoadjuvant systemic therapy, and 37 (32\%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31\%) and six (5\%) patients, respectively. At a median follow-up of 27 mo, 19 (16\%) patients developed CRPC and eight (7\%) patients died. The 1-yr urinary continence rate was 82\%. The 2-yr CRPC-free survival and OS were 85.8\% (95\% confidence interval [CI] 78.5-93.7\%) and 98.9\% (95\% CI 96.8-100\%), respectively. The limitations include retrospective design and short-term follow-up.CONCLUSIONS: Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy.PATIENT SUMMARY: We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.",

author = "Pawel Rajwa and Daniele Robesti and Michael Chaloupka and \{EAU-YAU Prostate Cancer Working Party (PCa-WP)\} and Fabio Zattoni and Alexander Giesen and Huebner, \{Nicolai A\} and Aleksandra Krzywon and Marcin Miszczyk and Matthias Moll and Rafa{\l} Stando and Edoardo Cisero and Sofiya Semko and Enrico Checcucci and Ga{\"e}tan Devos and Maria Apfelbeck and Cecilia Gatti and Giancarlo Marra and \{van den Bergh\}, \{Roderick C N\} and Gregor Goldner and Sazan Rasul and Francesco Ceci and \{Dal Moro\}, Fabrizio and Francesco Porpiglia and Paolo Gontero and Anders Bjartell and Christian Stief and Axel Heidenreich and Steven Joniau and Alberto Briganti and Shariat, \{Shahrokh F\} and Giorgio Gandaglia",

year = "2024",

month = aug,

day = "1",

doi = "10.1016/j.euo.2023.09.006",

language = "English",

volume = "7",

pages = "721--734",

journal = "European urology oncology",

issn = "2588-9311",

publisher = "Elsevier",

number = "4",

}

Rajwa, P, Robesti, D, Chaloupka, M, EAU-YAU Prostate Cancer Working Party (PCa-WP), Zattoni, F, Giesen, A, Huebner, NA, Krzywon, A, Miszczyk, M, Moll, M, Stando, R, Cisero, E, Semko, S, Checcucci, E, Devos, G, Apfelbeck, M, Gatti, C, Marra, G, van den Bergh, RCN, Goldner, G, Rasul, S, Ceci, F, Dal Moro, F, Porpiglia, F, Gontero, P, Bjartell, A, Stief, C, Heidenreich, A, Joniau, S, Briganti, A, Shariat, SF & Gandaglia, G 2024, 'Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study', European urology oncology, vol. 7, no. 4, pp. 721-734. https://doi.org/10.1016/j.euo.2023.09.006

Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study. / Rajwa, Pawel; Robesti, Daniele; Chaloupka, Michael et al.
In: European urology oncology, Vol. 7, No. 4, 01.08.2024, p. 721-734.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography

T2 - Results of a Multicenter European Study

AU - Rajwa, Pawel

AU - Robesti, Daniele

AU - Chaloupka, Michael

AU - EAU-YAU Prostate Cancer Working Party (PCa-WP)

AU - Zattoni, Fabio

AU - Giesen, Alexander

AU - Huebner, Nicolai A

AU - Krzywon, Aleksandra

AU - Miszczyk, Marcin

AU - Moll, Matthias

AU - Stando, Rafał

AU - Cisero, Edoardo

AU - Semko, Sofiya

AU - Checcucci, Enrico

AU - Devos, Gaëtan

AU - Apfelbeck, Maria

AU - Gatti, Cecilia

AU - Marra, Giancarlo

AU - van den Bergh, Roderick C N

AU - Goldner, Gregor

AU - Rasul, Sazan

AU - Ceci, Francesco

AU - Dal Moro, Fabrizio

AU - Porpiglia, Francesco

AU - Gontero, Paolo

AU - Bjartell, Anders

AU - Stief, Christian

AU - Heidenreich, Axel

AU - Joniau, Steven

AU - Briganti, Alberto

AU - Shariat, Shahrokh F

AU - Gandaglia, Giorgio

PY - 2024/8/1

Y1 - 2024/8/1

N2 - BACKGROUND: De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown.OBJECTIVE: To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET.DESIGN, SETTING, AND PARTICIPANTS: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET.INTERVENTION: Cytoreductive radical prostatectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed.RESULTS AND LIMITATIONS: Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up.CONCLUSIONS: Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy.PATIENT SUMMARY: We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.

AB - BACKGROUND: De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown.OBJECTIVE: To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET.DESIGN, SETTING, AND PARTICIPANTS: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET.INTERVENTION: Cytoreductive radical prostatectomy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed.RESULTS AND LIMITATIONS: Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up.CONCLUSIONS: Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy.PATIENT SUMMARY: We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.

UR - https://www.scopus.com/pages/publications/85199223734

U2 - 10.1016/j.euo.2023.09.006

DO - 10.1016/j.euo.2023.09.006

M3 - Article

C2 - 37845121

SN - 2588-9311

VL - 7

SP - 721

EP - 734

JO - European urology oncology

JF - European urology oncology

IS - 4

ER -

Rajwa P, Robesti D, Chaloupka M, EAU-YAU Prostate Cancer Working Party (PCa-WP), Zattoni F, Giesen A et al. Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study. European urology oncology. 2024 Aug 1;7(4):721-734. Epub 2023 Oct 14. doi: 10.1016/j.euo.2023.09.006

Outcomes of Cytoreductive Radical Prostatectomy for Oligometastatic Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography: Results of a Multicenter European Study

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