Lokale und Metastasen -gerichtete Therapieoptionen beim oligometastasierten Prostatakarzinom

Zusammenfassung

Die Weiterentwicklung systemischer Therapiekonzepte beim metastasierten Prostatakarzinom haben in der jüngeren Vergangenheit zu einer deutlichen Prognoseverbesserung geführt. Inwieweit durch lokale und/oder gezielte Metastasen-gerichtete Therapien neben Palliation, lokaler Kontrolle und Funktionserhalt ein zusätzlicher prognostischer Nutzen besteht, war lange unklar. Für die lokale Therapie der Prostata besteht aktuell die höchste Evidenz für die Strahlentherapie und zeigt bei „niedriger Metastasen-Tumorlast“ oligometastasierter Patienten einen signifikanten Überlebensvorteil. Metastasen-gerichtete operative oder radioonkologische Konzepte zeigen ebenfalls Möglichkeiten zur Verbesserung der Prognose auf, sind bislang aber noch unzureichend untersucht und sollten daher immer individuell und interdisziplinär diskutiert, dokumentiert und etabliert werden.

Abstract

New developments of systemic therapy concepts for metastatic prostate carcinoma have led to a significant improvement in the prognosis in the recent past. It has long been unclear to what extent local and/or metastasis-directed therapies have an additional oncologic benefit in addition to palliation, local control and functional maintenance. For local therapy of the prostate, the highest evidence currently exists for radiotherapy and shows a significantly increased overall survival in “low- burden” oligometastatic patients. Metastasis-directed surgical or radio-oncological concepts may also improve prognosis but have not yet been sufficiently investigated and should therefore be discussed, documented and established on an individual and interdisciplinary basis.

Schlüsselwörter

Prostatakarzinom - Oligometastasierung - Strahlentherapie - Metastasen-gerichtete Therapie

Keywords

prostate cancer - external beam radiation - metastasis-directed therapy - oligometastasis

• Literatur

• 1 Barnes B, Kraywinkel K, Nowossadeck E. et al. Bericht zum Krebsgeschehen in Deutschland 2016. Robert Koch-Institut; 2016
• 2 Mottet N, van den Bergh RCN, Briers E. et al. EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer 2020. In European Association of Urology Guidelines 2020 Edition. Arnhem: The Netherlands: European Association of Urology Guidelines Office; 2020
• 3 Boevé LMS, Hulshof M, Vis AN. et al. Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial. Eur Urol 2019; 75: 410-418
• 4 Culp SH, Schellhammer PF, Williams MB. Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. . Eur Urol 2014; 65: 1058-1066
• 5 Fossati N, Trinh QD, Sammon J. et al. Identifying optimal candidates for local treatment of the primary tumor among patients diagnosed with metastatic prostate cancer: a SEER-based study. Eur Urol 2015; 67: 3-6
• 6 Gratzke C, Engel J, Stief CG. Role of radical prostatectomy in metastatic prostate cancer: data from the Munich Cancer Registry. Eur Urol 2014; 66: 602-603
• 7 Rusthoven CG, Jones BL, Flaig TW. et al. Improved Survival With Prostate Radiation in Addition to Androgen Deprivation Therapy for Men With Newly Diagnosed Metastatic Prostate Cancer. J Clin Oncol 2016; 34: 2835-2842
• 8 Parker CC, James ND, Brawley CD. et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. The Lancet 2018; 392: 2353-2366
• 9 Sweeney CJ, Chen YH, Carducci M. et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med 2015; 373: 737-746
• 10 Heidenreich A, Pfister D, Porres D. Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol 2015; 193: 832-838
• 11 Heidenreich A, Fossati N, Pfister D. et al. Cytoreductive Radical Prostatectomy in Men with Prostate Cancer and Skeletal Metastases. European Urology Oncology 2018; 1: 46-53
• 12 Sooriakumaran P, Karnes J, Stief C. et al. A Multi-institutional Analysis of Perioperative Outcomes in 106 Men Who Underwent Radical Prostatectomy for Distant Metastatic Prostate Cancer at Presentation. Eur Urol 2016; 69: 788-794
• 13 Tilki D, Pompe RS, Bandini M. et al. Local treatment for metastatic prostate cancer: A systematic review. Int J Urol 2018; 25: 390-403
• 14 NCT02454543. Impact of Radical Prostatectomy as Primary Treatment in Patients With Prostate Cancer With Limited Bone Metastases - Full Text View. ClinicalTrials.gov. Available from (cited 2020 Nov. 13): https://clinicaltrials.gov/ct2/show/NCT02454543
• 15 Steuber T, Berg KD, Røder MA. et al. Does Cytoreductive Prostatectomy Really Have an Impact on Prognosis in Prostate Cancer Patients with Low-volume Bone Metastasis? Results from a Prospective Case-Control Study. . Eur Urol Focus 2017; 3: 646-649
• 16 Knipper S, Beyer B, Mandel P. et al. Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H. World Journal of Urology 2020; 38: 1459-1464
• 17 Gundem G, Van Loo P, Kremeyer B. et al. The evolutionary history of lethal metastatic prostate cancer. Nature 2015; 520: 353-357
• 18 Jilg CA, Schultze-Seemann W, Drendel V. et al. Detection of Lymph Node Metastasis in Patients with Nodal Prostate Cancer Relapse Using 18F/11C-Choline Positron Emission Tomography/Computerized Tomography. The Journal of Urology; 2014 192. 103-111 https://doi.org/10.1016/j.juro.2013.12.054
• 19 Perera M, Papa N, Roberts M. et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and Meta-analysis. Eur Urol 2020; 77: 403-417
• 20 Rischke HC, Eiberger A-K, Volegova-Neher N. et al. PET/CT and MRI directed extended salvage radiotherapy in recurrent prostate cancer with lymph node metastases. Adv Med Sci 2016; 61: 212-218
• 21 Ost P, Reynders D, Decaestecker K. et al. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. Journal of Clinical Oncology 2018; 36: 446-453
• 22 De Bleser E, Jereczek-Fossa BA, Pasquier D. et al. Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy. Eur Urol 2019; 76: 732-739
• 23 O'Shaughnessy MJ, McBride SM, Vargas HA. et al. A Pilot Study of a Multimodal Treatment Paradigm to Accelerate Drug Evaluations in Early-stage Metastatic Prostate Cancer. Urology 2017; 102: 164-172
• 24 Ost P, Reynders D, Decaestecker K. et al. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): Five-year results of a randomized phase II trial. Journal of Clinical Oncology 2020; 38: 10-10
• 25 Phillips R, Shi WY, Deek M. et al. Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial. JAMA Oncology 2020; 6: 650-659
• 26 Siva S, Bressel M, Murphy DG. et al. Stereotactic Abative Body Radiotherapy (SABR) for Oligometastatic Prostate Cancer: A Prospective Clinical Trial. European Urology 2018; 74: 455-462
• 27 Connor MJ, Smith A, Miah S. et al. Targeting Oligometastasis with Stereotactic Ablative Radiation Therapy or Surgery in Metastatic Hormone-sensitive Prostate Cancer: A Systematic Review of Prospective Clinical Trials. European Urology Oncology 2020; 3: 582-593