272 Background: Androgen deprivation (ADT) represents the standard treatment in men with prostate cancer (PCA) and osseous metastases. Unlike therapeutic approaches in other solid tumors, RP is usually ignored due to the common view that the biology of the disease is attributed to preexisting metastases. Recently, it has been shown that potentially lethal cancers persist even after neoadjuvant ADT and chemotherapy. We explored the outcome of patients with PCA and low volume skeletal metastases who were subjected to ADT and cytoreductive radical prostatectomy (CRP). Methods: Eighteen patients with biopsy proven, completely resectable PCA, minimal osseous metastases (equal to or less than three hot spots on bone scan), absence of visceral or extensive lymph node metastases were included in the pilot study. All patients (pts) underwent neoadjuvant ADT with luteinizing hormone-releasing hormone (LHRH) analogues for 6 months. If the PSA serum level decreased to less than 0.4 ng/ml and osseous lesions disappeared on control scan, pts were considered suitable for extended RP followed by 2 years adjuvant ADT. Results: Mean age was 61 (42 to 69), the mean PSA was 96.3 (72 to 139) ng/ml and 0.29 (0 to 0.39) ng/ml at recruitment and at 6 months, respectively. Mean number of bone lesions was 1.9 (1 to 3) and all lesions disappeared after 6 months of ADT. Pathohistology revealed pT2c in 4 (22.2%), pT3a and pT3b in 3 (16.7%) and 11 (61.11%) pts, respectively. Seven (38.9%) pts and three (16.7%) pts had lymph node metastases or positive surgical margins (PSM). PSM were treated with adjuvant radiation therapy ad 66.6Gy. No Clavien grade 3 to 5 complications occurred. The mean follow-up is 29 (3 to 52) months, three (16.7%) pts relapsed. The remainder is without evidence of disease. Conclusions: CRP is feasible in well selected men with low volume osseous metastases who respond well to neoadjuvant ADT. These men have a life expectancy of around 7 years and CRP reduces the risk of locally recurrent PCA and local complications. CRP might be a new treatment option in the multimodality management of PCA and minimal metastatic disease.
