[Local therapies for oligometastatic hormone-sensitive prostate cancer].

Stellenwert der lokalen Therapien beim oligometastasierten, hormonsensitiven Prostatakarzinom.

Androgen deprivation Metastasis, neoplasm Radiation therapy Radical prostatectomy Radiotherapy

Journal

Urologie (Heidelberg, Germany)

ISSN: 2731-7072

Titre abrégé: Urologie

Pays: Germany

ID NLM: 9918384886606676

Informations de publication

Date de publication:
08 Feb 2024

Historique:

accepted: 15 01 2024

medline: 8 2 2024

pubmed: 8 2 2024

entrez: 8 2 2024

Statut: aheadofprint

Résumé

Oligometastatic, hormone-sensitive prostate cancer (omHSPC) is increasingly diagnosed due to the implementation of molecular imaging. OmHSPC is mostly defined as a maximum of four bone metastases without visceral metastases on conventional imaging. This study highlights the existing evidence regarding local treatment of omHSPC, taking into account molecular imaging and modern therapies. Narrative review article based on expert consensus and national/international guideline recommendations, supported by a nonsystematic literature search in PubMed (MEDLINE). The authors consider the cited studies as the most significant works in this regard and these were selected to illustrate developments and fundamental concepts, without claiming completeness. Initially, the STAMPEDE study prospectively demonstrated an oncologic benefit of radiotherapy (RT) to the prostate in addition to androgen deprivation therapy for omHSPC. At 3 years, overall survival (OS) was 81% with RT versus 73% without RT (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.52-0.90; p = 0.007). However, this benefit was not observed in polymetastatic HSPC (HR 1.07; 95% CI 0.90-1.28; p = 0.4). In a study by Dai et al., local therapy for omHSPC was performed surgically in 85% of cases, also demonstrating an OS advantage (HR 0.44; 95% CI 0.24-0.81; p = 0.008). OmHSPC should be treated using adjunctive RT. Preliminary prospective evidence shows comparable efficacy with prostatectomy. Modern systemic combination therapies challenge the role of local therapy. HINTERGRUND: Das oligometastasierte, hormonsensitive Prostatakarzinom (omHSPC) ist aufgrund der Implementierung molekularer Bildgebung eine zunehmende Entität. Die Oligometastasierung ist zumeist definiert als maximal 4 Knochenmetastasen ohne viszerale Metastasen in der konventionellen Bildgebung. Diese Arbeit beleuchtet die Evidenz zur lokalen Behandlung des omHSPC unter Berücksichtigung der molekularen Bildgebung und moderner Therapien. Dieser narrative Übersichtsartikel auf der Grundlage von Expertenkonsens und nationalen/internationalen Leitlinien wird unterstützt durch eine Literaturrecherche in PubMed. Die zitierten Studien stellen nach Meinung der Autoren die wichtigsten Arbeiten hierzu dar und wurden ausgewählt, um Entwicklungen und prinzipielle Konzepte zu veranschaulichen, beanspruchen jedoch keine Vollständigkeit. Die STAMPEDE-Studie konnte 2018 erstmals prospektiv-randomisiert einen onkologischen Nutzen der lokalen Bestrahlung (RT) zusätzlich zur Androgendeprivationstherapie beim omHSPC nachweisen. Nach 3 Jahren war das Gesamtüberleben (OS) 81 % mit Bestrahlung vs. 73 % ohne Bestrahlung (Hazard Ratio [HR]: 0,68; 95 %-Konfidenzintervall [KI]: 0,52–0,90; p = 0,007). Beim polymetastasierten HSPC bestand dieser Nutzen hingegen nicht (HR: 1,07; 95 %-KI: 0,90–1,28; p = 0,4). In einer Studie von Dai et al. erfolgte die Lokaltherapie des omHSPC hingegen zu 85 % chirurgisch und auch hier zeigte sich ein OS-Vorteil (HR: 0,44; 95 %-KI: 0,24–0,81; p = 0,008). Das omHSPC soll mittels additiver RT behandelt werden. Erste prospektive Ergebnisse zeigen vergleichbare Wirksamkeit durch die Prostatektomie. Moderne medikamentöse Kombinationstherapien fordern die Lokaltherapie heraus.

Sections du résumé

BACKGROUND BACKGROUND

OBJECTIVES OBJECTIVE

This study highlights the existing evidence regarding local treatment of omHSPC, taking into account molecular imaging and modern therapies.

MATERIALS AND METHODS METHODS

Narrative review article based on expert consensus and national/international guideline recommendations, supported by a nonsystematic literature search in PubMed (MEDLINE). The authors consider the cited studies as the most significant works in this regard and these were selected to illustrate developments and fundamental concepts, without claiming completeness.

RESULTS RESULTS

Initially, the STAMPEDE study prospectively demonstrated an oncologic benefit of radiotherapy (RT) to the prostate in addition to androgen deprivation therapy for omHSPC. At 3 years, overall survival (OS) was 81% with RT versus 73% without RT (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.52-0.90; p = 0.007). However, this benefit was not observed in polymetastatic HSPC (HR 1.07; 95% CI 0.90-1.28; p = 0.4). In a study by Dai et al., local therapy for omHSPC was performed surgically in 85% of cases, also demonstrating an OS advantage (HR 0.44; 95% CI 0.24-0.81; p = 0.008).

CONCLUSION CONCLUSIONS

OmHSPC should be treated using adjunctive RT. Preliminary prospective evidence shows comparable efficacy with prostatectomy. Modern systemic combination therapies challenge the role of local therapy.

ZUSAMMENFASSUNG UNASSIGNED

HINTERGRUND: Das oligometastasierte, hormonsensitive Prostatakarzinom (omHSPC) ist aufgrund der Implementierung molekularer Bildgebung eine zunehmende Entität. Die Oligometastasierung ist zumeist definiert als maximal 4 Knochenmetastasen ohne viszerale Metastasen in der konventionellen Bildgebung.

ZIEL DER ARBEIT UNASSIGNED

Diese Arbeit beleuchtet die Evidenz zur lokalen Behandlung des omHSPC unter Berücksichtigung der molekularen Bildgebung und moderner Therapien.

MATERIAL UND METHODEN METHODS

Dieser narrative Übersichtsartikel auf der Grundlage von Expertenkonsens und nationalen/internationalen Leitlinien wird unterstützt durch eine Literaturrecherche in PubMed. Die zitierten Studien stellen nach Meinung der Autoren die wichtigsten Arbeiten hierzu dar und wurden ausgewählt, um Entwicklungen und prinzipielle Konzepte zu veranschaulichen, beanspruchen jedoch keine Vollständigkeit.

ERGEBNISSE UNASSIGNED

Die STAMPEDE-Studie konnte 2018 erstmals prospektiv-randomisiert einen onkologischen Nutzen der lokalen Bestrahlung (RT) zusätzlich zur Androgendeprivationstherapie beim omHSPC nachweisen. Nach 3 Jahren war das Gesamtüberleben (OS) 81 % mit Bestrahlung vs. 73 % ohne Bestrahlung (Hazard Ratio [HR]: 0,68; 95 %-Konfidenzintervall [KI]: 0,52–0,90; p = 0,007). Beim polymetastasierten HSPC bestand dieser Nutzen hingegen nicht (HR: 1,07; 95 %-KI: 0,90–1,28; p = 0,4). In einer Studie von Dai et al. erfolgte die Lokaltherapie des omHSPC hingegen zu 85 % chirurgisch und auch hier zeigte sich ein OS-Vorteil (HR: 0,44; 95 %-KI: 0,24–0,81; p = 0,008).

SCHLUSSFOLGERUNG UNASSIGNED

Das omHSPC soll mittels additiver RT behandelt werden. Erste prospektive Ergebnisse zeigen vergleichbare Wirksamkeit durch die Prostatektomie. Moderne medikamentöse Kombinationstherapien fordern die Lokaltherapie heraus.

Autres résumés

Type: Publisher (ger)

Identifiants

DOI: 10.1007/s00120-024-02280-z PMID: 38329485

pubmed: 38329485

doi: 10.1007/s00120-024-02280-z

pii: 10.1007/s00120-024-02280-z

doi:

Types de publication

English Abstract Journal Article Review

Langues

ger

Sous-ensembles de citation

Informations de copyright

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