Evaluating the effectiveness of cytoreductive surgery in oligometastatic prostate cancer: insights from quantitative analysis and retrospective cohort studies

Abstract

Background: Oligometastatic prostate cancer (OmPCa) is characterized by a restricted number of metastatic lesions confined to a limited organ range, presenting a distinct clinical challenge. The role of cytoreductive prostatectomy (CRP) in managing this specific metastatic stage has gained attention but remains controversial. This study aims to assess the effectiveness of CRP in OmPCa by synthesizing outcomes from previous studies and analyzing data from a multicenter, retrospective cohort.

Methods: We focused on evaluating overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), and castration-resistant prostate cancer-free survival (CRPCFS) as primary outcomes. A multicenter comparative retrospective analysis was also conducted on OmPCa patients treated with CRP versus those receiving androgen deprivation therapy (ADT) alone from January 2008 to June 2018. We gathered and analyzed data on patient demographics, tumor characteristics, surgical outcomes, and survival metrics.

Results: The quantitative analysis included 18 studies [2 randomized controlled trials (RCTs) and 16 non-RCT studies], comprising a total of 1733 patients with OmPCa, and this is the largest number of samples included in the same subject research at present. The pooled analysis demonstrated that cytoreductive surgery was associated with significantly improved OS [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.40-0.60], PFS (HR 0.39, 95% CI 0.27-0.51), CSS (HR 0.44, 95% CI 0.23-0.65), and CRPCFS (HR 0.48, 95% CI 0.36-0.59) compared to nonsurgical management. In addition, OS, PFS, and CRPCFS showed better results in the CRP group in all analyses (RCTs and non-RCTs). Additionally, in our multicenter retrospective research analysis, 64 patients with OmPCa were included, 32 underwent CRP (50%) and 32 underwent ADT alone (50%). The median follow-up time was 40.1 (18.9-51.3) months. The OS ( P =0.0182), PFS ( P =0.0297), and CRPCFS ( P =0.0125) had statistical differences between the two matched cohorts. Moreover, we observed 8 (25%) cases of perioperative complications, with the most common being urinary incontinence (9.4%).

Conclusions: Incorporating CRP alongside ADT in the treatment protocol for OmPCa significantly enhances patient outcomes in terms of OS, PFS, and CRPC-free survival, underscoring the potential benefit of this surgical approach in the specified patient population.

Figure 1

Flow diagram following the PRISMA template of the search strategy. ADT, androgen deprivation therapy; PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.

Figure 2

Forest plot of progression-free survival in cytoreductive radical prostatectomy (CRP) group and androgen deprivation therapy (ADT) group. HR, hazard ratio; RCT, randomized controlled trial.

Figure 3

Forest plot of castration-resistant prostate cancer (CRPC)-free survival in the cytoreductive radical prostatectomy (CRP) group and the androgen deprivation therapy (ADT) group. HR, hazard ratio; RCT, randomized controlled trial.

Figure 4

Forest plots of cancer-specific survival. HR, hazard ratio.

Figure 5

Forest plots of overall survival. HR, hazard ratio; RCT, randomized controlled trial.

Figure 6

Kaplan–Meier estimates of primary and secondary endpoints for the oligometastatic prostate cancer (OmPCa) cohort that underwent CRP: (A) progression-free survival, (B) overall survival, and (C) CRPC-free survival. ADT, androgen deprivation therapy; CRP, cytoreductive radical prostatectomy; CRPC, castration-resistant prostate cancer; OS, overall survival; PFS, progression-free survival.