Soichiro Yoshida1, Taro Takahara2,3, Yuki Arita4, Kazuma Toda5, Ichiro Yamada6, Hajime Tanaka7, Minato Yokoyama7, Yoh Matsuoka7, Ryoichi Yoshimura5, Yasuhisa Fujii7. 1. Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan. s-yoshida.uro@tmd.ac.jp. 2. Department of Biomedical Engineering, Tokai University School of Engineering, Kanagawa, 259-1292, Japan. 3. Department of Radiology, Advanced Imaging Center Yaesu Clinic, Tokyo, 113-0027, Japan. 4. Departments of Diagnostic Radiology, Keio University School of Medicine, Tokyo, 160-8582, Japan. 5. Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan. 6. Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan. 7. Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
Abstract
PURPOSE: To evaluate the clinical characteristics of genuine- and induced-oligometastatic castration-resistant prostate cancer (OM-CRPC) and assess the therapeutic effect of progressive-site directed therapy (PSDT). METHODS: We performed a retrospective analysis of 45 patients with OM-CRPC. Whole-body diffusion-weighted MRI (WB-DWI) was used to diagnose oligo-progressive disease. Based on the clinical and radiological findings, the OM-CRPCs were classified as genuine or induced. PSDT was performed with the intent to ablate all the progressive sites detected on WB-DWI with radiotherapy. Systemic therapy remained unchanged during and after PSDT. RESULTS: A total of 31 (69%) and 14 (31%) patients were diagnosed with genuine- and induced-OM-CRPC, respectively. The genuine-OM-CRPC group had significantly fewer patients treated with taxane-based chemotherapy and new hormonal drugs than the induced-OM-CRPC group. Of these, 26 OM-CRPC patients were treated with PSDT, and a 50% PSA decline was observed in 14 (93%) of 15 patients with genuine-OM-CRPC and 4 (36%) of 11 patients with induced-OM-CRPC (P = 0.033). Further, the duration of PSA-progression-free survival was significantly longer in the genuine-OM-CRPC group than in the induced-OM-CRPC group (8.7 vs. 5.8 months, P = 0.040). CONCLUSIONS: PSDT can be a promising treatment option for genuine-OM-CRPC. The procedure might also be considered effective for induced-OM-CRPC, although there was less therapeutic benefit of PSDT in patients with induced-OM-CRPC than in patients with genuine-OM-CRPC.
PURPOSE: To evaluate the clinical characteristics of genuine- and induced-oligometastatic castration-resistant prostate cancer (OM-CRPC) and assess the therapeutic effect of progressive-site directed therapy (PSDT). METHODS: We performed a retrospective analysis of 45 patients with OM-CRPC. Whole-body diffusion-weighted MRI (WB-DWI) was used to diagnose oligo-progressive disease. Based on the clinical and radiological findings, the OM-CRPCs were classified as genuine or induced. PSDT was performed with the intent to ablate all the progressive sites detected on WB-DWI with radiotherapy. Systemic therapy remained unchanged during and after PSDT. RESULTS: A total of 31 (69%) and 14 (31%) patients were diagnosed with genuine- and induced-OM-CRPC, respectively. The genuine-OM-CRPC group had significantly fewer patients treated with taxane-based chemotherapy and new hormonal drugs than the induced-OM-CRPC group. Of these, 26 OM-CRPC patients were treated with PSDT, and a 50% PSA decline was observed in 14 (93%) of 15 patients with genuine-OM-CRPC and 4 (36%) of 11 patients with induced-OM-CRPC (P = 0.033). Further, the duration of PSA-progression-free survival was significantly longer in the genuine-OM-CRPC group than in the induced-OM-CRPC group (8.7 vs. 5.8 months, P = 0.040). CONCLUSIONS:PSDT can be a promising treatment option for genuine-OM-CRPC. The procedure might also be considered effective for induced-OM-CRPC, although there was less therapeutic benefit of PSDT in patients with induced-OM-CRPC than in patients with genuine-OM-CRPC.
Entities:
Keywords:
Castration-resistant; Diffusion magnetic resonance imaging; Neoplasm metastasis; Prostatic neoplasms; Radiotherapy; Whole body imaging
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