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2 november 2018: lees ook dit artikel: 

https://kanker-actueel.nl/operatie-plus-bestraling-geeft-betere-overall-overleving-en-specifieke-prostaatkanker-overleving-op-10-jaar-dan-bestraling-plus-hormoontherapie-bij-in-lymfklieren-uitgezaaide-prostaatkanker-bij-de-diagnose.html

10 maart 2018: Bron: BJU International, First published:

Hoewel een operatie zelden wordt toegepast bij reeds in de botten uitgezaaide prostaatkanker blijkt nu uit een vergelijkende studie dat een robot-assisted radical prostatectomy (RARP) ( = operatieve verwijdering van de prostaat met de da Vinci robot) onterecht niet vaker wordt toegepast.

Want uit een vergelijkende studie bij totaal 79 prostaatkankerpatiënten, 38 patiënten werden behandeld met RARP en 41 kregen hormoontherapie (ADT)  zonder verdere lokale behandeling, blijkt de mediane progressievrije ziekte maar liefst 47 maanden langer en de mediane overall overleving is nog niet bereikt in de RARP groep versus 40 maanden in de groep die alleen hormoontherapie had gehad. (median PFS: 75 vs 28 months, P = 0.008; median CSS: not reached vs 40 months, P = 0.002). Ook waren er minder continentieklachten in de RARP groep.

Een groot verschil dus en dan te bedenken dat alle patiënten op zeker drie tot 5 plaatsen uitzaaiingen in de botten hadden. Wel zijn de patiënten door de behandeldn artsen geselecteerd en was het de keuze van de behandelend arts om RARP toe te passen. Het is dus geen blind gerandomiserde studie maar wel een vergelijkende studie memt dezelfde uitgangspunten.

En dan nog is het verschil zo groot dat je je kunt afvragen of bij prostaatkankerpatiënten waar nog nooit een verwijdering van de prostaat heeft plaatsgevonden dit niet alsnog zou moeten worden gedaan. Ook als er nog steeds botuitzaaiingen zijn.

Voor alle patiënten was de mediane follow-up-tijd 40 maanden ( 28-58). De patiënten in de RARP-groep waren jonger dan die in de ADT-groep (P <0,001). Er waren geen significante verschillen in PSA-waarden, Charlson-co-morbiditeitsindexen, Gleason-scores van de biopsies en klinische klasse indelingen tussen de twee groepen.

Table 1. Patient characteristics
CharacteristicADT (N = 41)RARP (N = 38)P

  1. ADT, androgen deprivation therapy; IQR, interquartile range; RARP, robot-assisted radical prostatectomy.
Median (IQR) age, years 71 (67−76) 65 (62−69) <0.001
Median (IQR) PSA, ng/mL 50.0 (23.8−162.8) 39.0 (15.0−84.5) 0.206
Charlson comorbidity index, n (%)     0.462
0 28 (68.3) 29 (76.3)  
≥1 13 (31.7) 9 (23.7)  
Biopsy Gleason score, n (%)     0.484
≤8 24 (58.5) 26 (68.4)  
≥9 17 (41.5) 12 (31.6)  
Clinical T stage, n (%)     0.252
≤cT2 2 (4.9) 5 (13.2)  
≥cT3 39 (95.1) 33 (86.8)  
Clinical N stage, n (%)     0.117
cN0 15 (36.6) 21 (55.3)  
cN1 26 (63.4) 17 (44.7)  
Neoadjuvant ADT, n (%)      
No NA 16 (42.1)  
Yes NA 22 (57.9)  

Figure 1.

Het volledige studierapport: Does robot-assisted radical prostatectomy benefit patients with prostate cancer and bone oligometastases? is gratis in te zien.

Hier het abstract van deze studie:

RARP in the setting of oligometastatic PCa is a safe and feasible procedure that improves oncological outcomes in terms of PFS and CSS. In addition, RARP effectively prevents urinary tract complications from PCa. Based on the present results, we believe RARP might be a treatment option in the management of oligometastatic PCa.

Does robot-assisted radical prostatectomy benefit patients with prostate cancer and bone oligometastases?

Authors

Abstract

Objective

To investigate the peri-operative and oncological outcomes of robot-assisted radical prostatectomy (RARP) in patients with oligometastatic prostate cancer (PCa).

Patients and Methods

We retrospectively reviewed the records of 79 patients with oligometastatic PCa treated with RARP or androgen deprivation therapy (ADT) between 2005 and 2015 at our institution. Of these 79 patients, 38 were treated with RARP and 41 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated peri-operative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analysed data using Kaplan–Meier methods, with log-rank tests and multivariate Cox regression models.

Results

Patients treated with RARP experienced similar postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than ADT-treated patients. PFS and CSS were longer in RARP-treated compared with ADT-treated patients (median PFS: 75 vs 28 months, P = 0.008; median CSS: not reached vs 40 months, P = 0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio 0.388, P = 0.003; CSS: HR 0.264, P = 0.004).

Conclusions

We showed that RARP in the setting of oligometastatic PCa is a safe and feasible procedure which improves oncological outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. The study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa; to confirm our findings, large, prospective, multicentre studies are required.

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prostaatkanker, da Vinci, operatie, hormoontherapie, PSA, botuitzaaiingen, ziekte progressie vrije tijd


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