Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H

PURPOSE: STAMPEDE arm H demonstrated a survival benefit for newly diagnosed prostate cancer (PCa) patients with low metastatic burden (LMB) who additionally received radiotherapy (RT) to the primary. However, it is unknown if radical prostatectomy (RP) may achieve equivalent results, since existing studies did neither include the same selection criteria nor examine comparable endpoints as STAMPEDE arm H.

METHODS: We retrospectively analysed 78 RP patients (2008-2018) with LMB (< 4 bone metastases) as defined in the subgroup analysis of STAMPEDE arm H. Like in STAMPEDE, overall (OS), metastatic progression-free (MPFS), and PCa-specific (CSS) survival at 3 years, as well as complication and continence rates were assessed.

RESULTS: Median age was 64 years. Median follow-up was 36 months. Median initial prostate-specific antigen was 35 ng/ml. At 3 years, OS was 91%, MPFS was 63%, and CSS was 92%, while 81%, 67%, and 86%, respectively, were reported in the RT subgroup with LMB in STAMPEDE arm H. Clavien-Dindo grade III-IV complications were observed in 16 (21%) patients. Of 38 patients with available continence data, 28 (74%) patients were continent and 2 (5%) patients needed ≥ 3 pads/day at 1 year after RP.

CONCLUSIONS: When comparing our RP cohort with the results of STAMPEDE arm H with LMB who received RT, no major disadvantage in OS and CSS may be expected. Since local treatment in patients with LMB might now be considered the new standard, RP should be further explored as local treatment option in these patients.