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Metastatic hormone sensitive prostate cancer: local treatment strategies

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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 17 March 2021

Abstract

Purpose

The landscape of the management of metastatic prostate cancer is changing rapidly and there is growing interest in the local treatment of the primary in these patients. The effect of local treatment on the outcome of metastatic prostate cancer patients was addressed based on retrospective analysis but now also based on prospective randomized trials. This article provides an overview of the currently available literature in this field.

Methods

A literature review was done searching the Medline database for English language articles using the keywords “metastatic prostate cancer”, and “local treatment”, “radiotherapy”, “prostatectomy”. The data of prospective randomized studies and the data of case–control studies or retrospective analysis were summarized in a narrative fashion.

Results

Data from two prospective randomized trials exploring the effect of local treatment of the prostate in hormone-sensitive metastatic prostate cancer showed no improvement of overall survival in the individual overall cohorts as well as in the pooled analysis (HR 0.92, 95% CI 0.81–1.04). There was an improvement of failure-free survival (pooled analysis HR 0.76, 95% CI 0.69–0.0.84). There was also an improved overall survival associated with radiotherapy in patients with < 5 metastases and with low volume disease. Data from prospective non-randomized or retrospective studies are inconclusive and underlies major selection biases.

Conclusion

Based on prospective randomized trials, local treatment by radiotherapy does not improve the overall survival in unselected metastatic prostate cancer patients. An effect can be seen in low volume patients or patients with < 5 metastases.

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Authors and Affiliations

  1. Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite/ B.P.: 156, 13273, Marseille, France

    Jochen Walz, Geraldine Pignot, Sami Fakhfakh & Jennifer Campagna

  2. Department of Medical Oncology, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Mathilde Guerin, Cecile Vicier & Gwenaelle Gravis

  3. Department of Radiology, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Serge Brunelle

  4. Department of Radiotherapy, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Naji Salem

Authors
  1. Jochen Walz
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  2. Geraldine Pignot
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  3. Sami Fakhfakh
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  4. Jennifer Campagna
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  5. Mathilde Guerin
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  6. Cecile Vicier
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  7. Serge Brunelle
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  8. Naji Salem
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  9. Gwenaelle Gravis
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Contributions

Protocol/project development: JW, GP, GG. Data collection or management: JW, GP. Data analysis: JW, GP, GG. Manuscript writing/editing: GP, SF, JC, MG, CV, SB, NS, GG.

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Correspondence to Jochen Walz.

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Walz, J., Pignot, G., Fakhfakh, S. et al. Metastatic hormone sensitive prostate cancer: local treatment strategies. World J Urol 39, 327–337 (2021). https://doi.org/10.1007/s00345-020-03296-8

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  • DOI: https://doi.org/10.1007/s00345-020-03296-8

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