The Cytoreductive prostatectomy in Metastatic Prostate Cancer: What the individual trials are hoping to answer.

Abstract

To review the ongoing randomized trials of cytoreductive prostatectomy (CRP) in de novo hormone sensitive metastatic prostate cancer (HSPC) in order to identify their goals and assess their strengths and weaknesses. Pubmed, Medline and clinical trials websites searches were performed in order to identify currently ongoing trials of CRP in de novo HSPC. Nine randomized clinical trials in CRP were identified and included: SWOG 1802, SIMCAP, IP2-ATLANTA, TROMBONE, g-RAMPP, LOMP II, FUSCC-OMPCa and the Testing Radical Prostatectomy in Chinese Men with Prostate Cancer and oligoMetastases to the Bone study. Each study was different; assessing various primary outcome measures including overall survival, progression free survival and feasibility to randomize between standard therapy and CRP or between radiation therapy and CRP in the metastatic setting. In the oligometastatic setting, the trials assess OS, feasibility to randomize and time to castration. Similarly a number of secondary endpoints ranging from cancer specific outcomes to quality of life outcomes are being investigated. The inclusion criteria in these trials also varied in terms of volume of metastatic disease (oligo-metastatic to high volume metastatic disease), diagnosis of metastases (imaging based vs biopsy proven), imaging modalities used (conventional to newer modalities) as well as outcomes and follow-up regimes. While there are differences in each protocol, each trial aims to address different aspects of CRP in de novo HSPC. Therefore the specific goals of each study and the limitations have to be taken into consideration when interpreting the results of these trials.