Androgen deprivation therapy (ADT)-free survival is longer with metastasis-directed therapy (MDT) than with surveillance alone in patients with oligorecurrent prostate cancer, according to a recent study.
Previous studies have indicated that MDT is associated with improved progression-free survival in patients with the disease.
To further explore the benefits of MDT in this patient population, Piet Ost, MD, PhD, Ghent University (Belgium), and colleagues assessed 62 patients with asymptomatic prostate cancer from August 2012 to August 2015 (median follow-up, 3 years). All patients included in the study had had a biochemical recurrence following primary prostate cancer treatment with curative intent, three or fewer extracranial metastatic lesions on choline PET-CT, and serum testosterone levels of more than 50 ng/mL.
Patients were randomly assigned to receive either surveillance or MDT of all detected lesions.
Surveillance was performed with prostate-specific antigen (PSA) follow-up every 3 months, and imaging was repeated at PSA progression or clinical suspicion for progression. The primary end point was defined as ADT-free survival. ADT was started with any symptomatic progression, progression to more than three metastases, or local progression of known metastases.
Results of the study indicated that the median ADT-free survival was 13 months in the surveillance group and 21 months in the MDT group (hazard ratio, 0.60). Quality of life, which had been similar between groups at baseline, remained comparable at 3-month and 1-year follow-up.
The researchers noted that grade 1 toxicity had occurred in six patients in the MDT group, and that no grade 2 or 5 toxicity had occurred.
“ADT-free survival was longer with MDT than with surveillance alone for oligorecurrent [prostate cancer], suggesting that MDT should be explored further in phase III trials,” the researchers concluded.—Christina Vogt