Multimodal Strategy Shows Promise in Metastatic Prostate Cancer

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An aggressive combination of systemic therapy with surgery and radiation proved effective for metastatic prostate cancer.
An aggressive combination of systemic therapy with surgery and radiation proved effective for metastatic prostate cancer.

Results from a pilot study suggest a new paradigm that includes drug therapy, surgery, and radiation may cure previously incurable metastatic prostate cancer.

Investigators at Memorial Sloan Kettering Cancer Center in New York, New York, demonstrated that an aggressive combination of systemic therapy combined with surgery and radiation directed at both the primary tumor and metastases can eliminate all detectable disease in selected patients with metastatic prostate cancer.

In this study, 20 men with metastatic prostate cancer (5 with extra-pelvic lymph nodal disease and 15 with bone lesions, with or without nodal disease) were treated with androgen deprivation therapy (ADT). They also underwent radical surgery with retroperitoneal lymph node dissection as needed, and radiation therapy to visible metastatic bone lesions.

Of the 5 patients with extra-pelvic lymph node involvement, an undetectable PSA was achieved after ADT and surgery in 4 patients; the fifth patients underwent radiation therapy as well to reach this milestone. However, none achieved the primary end point of undetectable PSA with testosterone recovery at 20 months after initiation of ADT alone. Only one patient had a PSA of less than .05 ng/mL with a testosterone level of 47 ng/dL at 39 months. Of the 15 patients with bone metastases, 14 (93%) reached an undetectable PSA with ADT, surgery, and radiation.

A phase 2 trial is planned. The researchers are working toward developing a sequentially applied multimodal treatment strategy that can eliminate detectable disease in selected patients with metastatic spread at diagnosis. In addition, they propose the end point of undetectable PSA after testosterone recovery should be considered when evaluating new approaches in early metastatic disease states.

Reference

1. O'Shaughnessy MJ, McBride SM, Vargas HA, et al. A pilot study of a multimodal treatment paradigm to accelerate drug evaluations in early-stage metastatic prostate cancer. Urology. 2017;102:164-172.

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