PMID- 37945451 OWN - NLM STAT- MEDLINE DCOM- 20240122 LR - 20240201 IS - 1873-7560 (Electronic) IS - 0302-2838 (Linking) VI - 85 IP - 2 DP - 2024 Feb TI - The Efficacy and Safety of Metastasis-directed Therapy in Patients with Prostate Cancer: A Systematic Review and Meta-analysis of Prospective Studies. PG - 125-138 LID - S0302-2838(23)03209-8 [pii] LID - 10.1016/j.eururo.2023.10.012 [doi] AB - CONTEXT: Despite the lack of level 1 evidence, metastasis-directed therapy (MDT) is used widely in the management of metastatic prostate cancer (mPCa) patients. Data are continuously emerging from well-designed prospective studies. OBJECTIVE: To summarise and report the evidence on oncological and safety outcomes of MDT in the management of mPCa patients. EVIDENCE ACQUISITION: We searched the PubMed, Scopus, and Web of Science databases for prospective studies assessing progression-free survival (PFS), local control (LC), androgen deprivation therapy (ADT)-free survival (ADT-FS), overall survival (OS), and/or adverse events (AEs) in mPCa patients treated with MDT. A meta-analysis was performed for 1- and 2-yr PFS, LC, ADT-FS, OS, and rate of AEs. Meta-regression and sensitivity analysis were performed to account for heterogeneity and identify moderators. EVIDENCE SYNTHESIS: We identified 22 prospective studies (n = 1137), including two randomised controlled trials (n = 116). Two studies were excluded from the meta-analysis (n = 120). The estimated 2-yr PFS was 46% (95% confidence interval [CI]: 36-56%) or 42% (95% CI: 33-52%) after excluding studies using biochemical or ADT-related endpoints. The estimated 2-yr LC, ADT-FS, and OS were 97% (95% CI: 94-98%), 55% (95% CI: 44-65%), and 97% (95% CI: 95-98%), respectively. Rates of treatment-related grade 2 and >/=3 AEs were 2.4% (95% CI: 0.2-7%) and 0.3% (95% CI: 0-1%), respectively. CONCLUSIONS: MDT is a promising treatment strategy associated with favourable PFS, excellent LC, and a low toxicity profile that allows oligorecurrent hormone-sensitive patients to avoid or defer ADT-related toxicity. Integration of MDT with other therapies offers a promising research direction, in particular, in conjunction with systemic treatments and as a component of definitive care for oligometastatic PCa. However, in the absence of randomised trials, using MDT for treatment intensification remains an experimental approach, and the impact on OS is uncertain. PATIENT SUMMARY: Direct treatment of metastases is a promising option for selected prostate cancer patients. It can delay hormone therapy and is being investigated as a way of intensifying treatment at the expense of manageable toxicity. CI - Copyright (c) 2023 The Author(s). Published by Elsevier B.V. All rights reserved. FAU - Miszczyk, Marcin AU - Miszczyk M AD - Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; IIIrd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland. FAU - Rajwa, Pawel AU - Rajwa P AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland. FAU - Yanagisawa, Takafumi AU - Yanagisawa T AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan. FAU - Nowicka, Zuzanna AU - Nowicka Z AD - Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland. FAU - Shim, Sung Ryul AU - Shim SR AD - Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea. FAU - Laukhtina, Ekaterina AU - Laukhtina E AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. FAU - Kawada, Tatsushi AU - Kawada T AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. FAU - von Deimling, Markus AU - von Deimling M AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Pradere, Benjamin AU - Pradere B AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France. FAU - Rivas, Juan Gomez AU - Rivas JG AD - Department of Urology, Hospital Clinico San Carlos, Madrid, Spain. FAU - Gandaglia, Giorgio AU - Gandaglia G AD - Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy. FAU - van den Bergh, Roderick C N AU - van den Bergh RCN AD - Department of Urology, St Antonius Hospital, Utrecht, The Netherlands. FAU - Goldner, Gregor AU - Goldner G AD - Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. FAU - Supiot, Stephane AU - Supiot S AD - Department of Radiotherapy, ICO Rene Gauducheau, Saint-Herblain, France. FAU - Zilli, Thomas AU - Zilli T AD - Department of Radiation Oncology, Oncological Institute of Southern Switzerland (IOSI-EOC), Bellinzona, Switzerland. FAU - Trinh, Quoc-Dien AU - Trinh QD AD - Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Nguyen, Paul L AU - Nguyen PL AD - Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. FAU - Briganti, Alberto AU - Briganti A AD - Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy. FAU - Ost, Piet AU - Ost P AD - Department of Radiation Oncology, Iridium Network, Wilrijk, Belgium. FAU - Ploussard, Guillaume AU - Ploussard G AD - Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France. FAU - Shariat, Shahrokh F AU - Shariat SF AD - Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA. Electronic address: shahrokh.shariat@meduniwien.ac.at. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20231107 PL - Switzerland TA - Eur Urol JT - European urology JID - 7512719 RN - 0 (Androgen Antagonists) RN - 0 (Hormones) SB - IM MH - Male MH - Humans MH - *Prostatic Neoplasms/drug therapy MH - Prospective Studies MH - Androgen Antagonists/adverse effects MH - Progression-Free Survival MH - Hormones OTO - NOTNLM OT - Metastasectomy OT - Metastasis-directed therapy OT - Oligometastatic OT - Prostate cancer OT - Radiation therapy EDAT- 2023/11/10 00:44 MHDA- 2024/01/22 06:42 CRDT- 2023/11/09 21:55 PHST- 2023/03/28 00:00 [received] PHST- 2023/09/15 00:00 [revised] PHST- 2023/10/16 00:00 [accepted] PHST- 2024/01/22 06:42 [medline] PHST- 2023/11/10 00:44 [pubmed] PHST- 2023/11/09 21:55 [entrez] AID - S0302-2838(23)03209-8 [pii] AID - 10.1016/j.eururo.2023.10.012 [doi] PST - ppublish SO - Eur Urol. 2024 Feb;85(2):125-138. doi: 10.1016/j.eururo.2023.10.012. Epub 2023 Nov 7.