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Treatment Without ADT Delays Initiation of Systemic Therapy in Prostate Cancer

Metastasis-directed therapy can delay initiation of systemic therapy in patients with solitary oligorecurrent metastatic lesion

MONDAY, Nov. 21, 2022 (HealthDay News) — For prostate cancer patients with a solitary oligometastatic lesion, metastasis-directed therapy without androgen deprivation therapy (ADT) can delay initiation of systemic therapy, according to a study published in the December issue of The Journal of Urology.

Jack R. Andrews, M.D., from Mayo Clinic Arizona in Phoenix, and colleagues characterized outcomes among 124 patients with prostate cancer from 2008 to 2018 with a solitary oligorecurrent metastatic lesion on positron emission tomography imaging who were treated with metastasis-directed therapy without ADT. Patients were treated with stereotactic body radiation therapy (57 patients; median follow-up, 53 months) or surgical excision (67 patients; median follow-up, 54 months).

The researchers found that 80.5 percent of the patients treated with surgery had >50 percent decline in prostate-specific antigen at the first follow-up, with 29 percent three-year radiographic progression-free survival. In this cohort, the median time to initiation of systemic therapy was 18.5 months. Overall, 40.3 percent of patients treated with stereotactic body radiation had >50 percent decline in prostate-specific antigen at first follow-up, with 17 percent three-year progression-free survival. The median time to initiation of systemic therapy was 17.8 months.

“These results suggest that metastasis-directed therapy without androgen deprivation therapy can delay initiation of systemic therapy and highlight the need for further prospective study for select patients with solitary metastatic recurrences of prostate cancer,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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