Multimodal Primary Treatment of Metastatic Prostate Cancer with Androgen Deprivation and Radiation

Abstract

Aim: We combined anti-androgen therapy with radiotherapy in a first-line setting for metastatic prostate cancer aiming to cause maximal cancer-cell death to delay the emergence of castration-resistant disease.

Materials and methods: In this non-randomized retrospective series of 46 patients, the initial median prostate-specific antigen (PSA) was 98.5 μg/l (range=6.7-15,500), median Gleason score 9 and most men had at least T₃N₁M₁ disease. All patients received luteinizing hormone releasing hormone analog or degarelix with bicalutamide. If PSA remained above 1 μg/l, docetaxel was initiated. At PSA nadir, all patients received radical radiotherapy of the prostate.

Results: The median follow-up time was 4.38 years (range=0.36-11.24). Most radiotherapy-related adverse events were grade 1 and transient. There were no grade 4 events. Overall survival (OS) at 5 years was 81.3%.

Conclusion: The feasibility and safety of aggressive multimodality treatment were good resulting in an excellent median OS of 8.35 years.

Keywords: HDR brachytherapy; Ra-223; Retrospective; Sm-153; VMAT; chemotherapy; experimental approach; hormone therapy; metastatic prostate cancer; multimodality; non-randomized; radiotherapy.