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Cited by 96Prostate Cancer Treatment and ResearchProstate Cancer Diagnosis and TreatmentManagement of metastatic bone disease

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Metastasis-directed Therapy Prolongs Efficacy of Systemic Therapy and Improves Clinical Outcomes in Oligoprogressive Castration-resistant Prostate Cancer

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Deek, Matthew P., Taparra, Kekoa, Phillips, Ryan, Velho, Pedro Isaacsson, Gao, Robert W., Deville, Curtiland, Song, Daniel Y., Greco, Stephen, Carducci, Michael, Eisenberger, Mario, DeWeese, Theodore L., Denmeade, Samuel, Pienta, Kenneth, Paller, Channing J., Antonarakis, Emmanuel S., Olivier, Kenneth R., Park, Sean S., Tran, Phuoc T., Stish, Bradley J.·2021·European Urology Oncology
DOI 10.1016/j.euo.2020.05.004PMC PMC7788526
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Abstract

Background Available therapies for castrate-resistant prostate cancer (CRPC) confer minimal survival advantage; thus, there is interest in metastasis-directed therapy (MDT) for oligometastatic or oligoprogressive disease to improve outcomes. Here, we describe outcomes of oligoprogressive CRPC treated with stereotactic ablative radiotherapy (SABR). Objective To report outcomes of oligoprogressive CRPC treated with MDT using SABR. Design, setting, and participants Patients with oligoprogressive CRPC were retrospectively evaluated, and outcomes following MDT were reported. Outcomes were additionally compared with oligoprogressive CRPC treated with change in systemic therapy alone. Intervention SABR to oligoprogressive lesions. Outcome measurements and statistical analysis Outcomes of interest were time to prostate-specific antigen (PSA) failure, time to next intervention (TTNI), distant metastasis-free survival (DMFS), and overall survival. Survival analysis was performed using the Kaplan-Meier method, and univariable analysis and multivariable analysis (MVA) were performed. Results and limitations A total of 68 patients were included. After MDT, median time to PSA recurrence, TTNI, and DMFS were 9.7, 15.6, and 10.8 months, respectively. A total of 112 lesions were treated, and the cumulative incidences of local failure at 12 and 24 months were 2.1% and 13.8%, respectively. Factors associated with the risk of local recurrence on univariable analysis were age (hazard ratio [HR] 1.07, p = 0.03) and Gleason grade group (HR 2.20, p = 0.07). Compared with change in systemic therapy alone (n = 52), MDT (n = 31) was associated with improved median time to PSA failure (9.7 vs 4.2 months, p = 0.066)), TTNI (14.9 vs 8.8 months, p = 0.025), and DMFS (12.7 vs 8.9 months, p = 0.045), and remained associated with improved outcomes on MVA. Conclusions In a retrospective cohort of oligoprogressive CRPC patients, MDT was associated with favorable outcomes and improved cancer control as compared with change in systemic treatment alone. Future prospective trials are needed to confirm these findings. Patient summary In this report, we retrospectively analyzed outcomes of patients with oligoprogressive castrate-resistant prostate cancer treated with radiation therapy to progressing lesions. Our results suggest that treatment of these lesions with radiation therapy can result in sustained periods of disease-free survival and might add benefit in addition to systemic therapy at the time of progression. These results need to be verified in a prospective trial to identify the optimal integration of radiation therapy into metastatic castrate-resistant prostate cancer.

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  • Several retrospective series have evaluated outcomes of patients with oligoprogressive CRPC lesions treated with metastasis-directed therapy, demonstrating improved PFS and delays in systemic therapy change.

    “Several retrospective series have evaluated the outcomes of patients with oligoprogressive CRPC lesions treated with metastasis-directed therapy, demonstrating improved PFS and delays in systemic therapy change [30, 46].”

    From Navigating therapeutic sequencing in the metastatic castration-resistant prostate cancer patient journey (2025) · cites this paper as [46]

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Research works printed but not linked: 23

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Metadata

Authors
Deek, M. P., Taparra, K., Phillips, R., Velho, P. I., Gao, R. W., Deville, C., Song, D. Y., Greco, S., Carducci, M., Eisenberger, M., DeWeese, T. L., Denmeade, S., Pienta, K., Paller, C. J., Antonarakis, E. S., Olivier, K. R., Park, S. S., Tran, P. T., & Stish, B. J.
Affiliations
  • Johns Hopkins University (US)
  • Mayo Clinic (US)
Corresponding author
Stish, Bradley J.
ORCID
Venue
European Urology Oncology
Publisher
Elsevier BV
Published
2021-06
Volume
4
Issue
3
Pages
447-455
ISSN
2588-9311 (ISSN-L)
DOI
10.1016/j.euo.2020.05.004
PMC
PMC7788526
OpenAlex
W3034430250
Cited by
96
References
28
Citations by year
2026: 8 · 2025: 14 · 2024: 20 · 2023: 8 · 2022: 24 · 2021: 22
FWCI
7.75
Type
journal article
Language
en
Open access
Licence
Locations
  • European Urology Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Movember-PCF
  • Babara's Fund
  • NIH/NCI (U01CA212007, U01CA231776, R21CA223403, R01 CA200551)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Prostate Cancer Treatment and Research
  • Health Sciences › Medicine › Urology › Prostate Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Management of metastatic bone disease
Keywords
metastasis-directed therapy, stereotactic body radiotherapy, oligometastatic disease, PSA failure, distant metastasis-free survival, overall survival, local recurrence, Gleason grade, age, prostate cancer treatment outcomes
MeSH terms
Progression-Free Survival, Humans, Male, Retrospective Studies, Radiosurgery, Prostate-Specific Antigen, Prostatic Neoplasms, Castration-Resistant

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