All forms of metastatic prostate cancer have been considered incurable in the past. However, in the recent years, FDA has approved 6 drugs for men with metastatic disease, all of these can increase survival. In a study published in Urology, researchers demonstrate for the 1st time that a combination of systemic therapy (Drug therapy) + local therapy (Surgery and radiation) is directed both at primary tumor and metastatic prostate cancer.
While the study is only an initial step, 1/5th of the patients treated had no detectable disease, with non-detectable PSA (Prostate specific antigen) and normal blood testosterone after 20 months. These findings suggest that some men who were previously considered to be incurable, can be cured with various drug combinations that cannot be achieved by single therapy alone.
The study:
25men with metastatic prostate cancer, 5 with extra pelvic lymph nodal disease and 15 with bone or with/without nodal disease were treated with Androgen deprivation therapy(ADT), radical surgery – retroperitoneal lymph node dissection + radiation therapy- visible metastatic lesions in bone. ADT was stopped after a minimum of 6 months if an undetectable PSA was achieved after combined modality therapy. Other patients were given continuous treatment.
The combined treatment protocol along with surgery was well tolerated. However, the role of local therapy in metastatic prostate cancer is still under investigation, resection of visible disease by experienced surgeons was critical to the outcome.
1 of the 5 patients with extra-pelvic lymph node involvement, 4 achieved and undetectable PSA after ADT and surgery while the 5-required radiation to reach this milestone. Although, none achieved the primary end of undetectable PSA with testosterone recovery @ 20 months after initiation of therapy with ADT alone, 1 patient had a PSA of <.05ng/ml with a testosterone level of 47 ng/dl @39 months.
Of the 15 patients with bone metastases, 14 reached an undetectable PSA when ADT, Surgery and radiation were used. Ultimately, 4 achieved the proposed end, a PSA of <.05 ng/ml and serum testosterone of >150 ng/dl at 20 months after the start of ADT, which remained undetectable in 2 patients for 27 and 46 months respectively.
The end deserves special mention, as the final point of undetectable PSA after testosterone recovery has been previously discussed but rarely studied. Researchers proposed that this may be the first step in establishing a curative option. Though the longevity of effect is essential to prove the point of curability, this step can be used to assess the possibility of cure in a reasonable period.