EURURO Vol. 72 No. 2

E31 320

Letter to the Editor
Reply to Pascal Mouracade’s Letter to the Editor re:
Giorgio Gandaglia, Nicola Fossati, Armando Stabile, et al.
Radical Prostatectomy in Men with Oligometastatic
Prostate Cancer: Results of a Single-institution Series
with Long-term Follow-up. Eur Urol 2017;72:289–92.
Do the Data Violate Kaplan-Meier Assumptions?
We thank Dr. Mouracade for his comments regarding our
recently published study assessing the safety and effective-
ness of radical prostatectomy (RP) in patients with
oligometastatic prostate cancer (PCa) . Our study focused
on a highly selected cohort of 11 patients with oligometa-
static disease treated with RP at a high-volume institution
between 2006 and 2011. At a median follow-up of 63 mo we
observed clinical recurrence in six patients and cancer-
specific mortality in two cases. This translated into 7-yr
clinical recurrence-free survival of 45% and cancer-specific
mortality–free survival of 82% according to Kaplan-Meier
analyses.
In his letter, Mouracade highlights that the statistical
approach adopted resulted in wide confidence intervals and
states that our results should be used with caution when
assessing the oncologic efficacy of RP in oligometastatic
PCa. These points were already acknowledged in our
manuscript . In particular, we decided to focus on
long-term outcomes, so we identified patients with
minimum follow-up of 5 yr. The inclusion of a small group
of highly selected patients inevitably resulted in wide
confidence intervals for survival analyses. Moreover, the
lack of a control group and the retrospective nature of our
investigation precluded strong conclusions on the oncologic
efficacy of RP in oligometastatic patients. Although available
population-based studies supporting the efficacy of local
treatments in oligometastatic PCa include a greater number
of patients and a control group the lack of details on
disease characteristics, the definition of oligometastatic
disease, and the use of additional cancer therapies strongly
limits their applicability in the clinical setting. Conversely,
our study has the advantage of inclusion of a series with
highly detailed data such as number of metastases,
perioperative outcomes, and the use of additional cancer
therapies. Moreover, patients included in our cohort have the
longest available follow-up when considering investigations
assessing the impact of RP on oncologic outcomes in the
oligometastatic setting.
Continuous efforts should be made to understand the
biology of oligometastatic PCa and the rationale for local
therapies in this setting, and results from ongoing random-
ized trials are badly needed to comprehensively assess the
role of RP in this scenario Meanwhile, observations in
retrospective cohorts with adequate patient information and
sufficient follow-up should drive the design of prospective
studies addressing this issue.
Conflicts of interest: The authors have nothing to disclose.
References
[1]
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[2]
[3]
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[5]
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Giorgio Gandaglia*
Nicola Fossati
Francesco Montorsi
Alberto Briganti
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS
Ospedale San Raffaele, Milan, Italy
*Corresponding author. Division of Oncology/Unit of Urology,
Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Tel. +39 02 26435663; Fax: +39 02 26437286.
E-mail address: (G. Gandaglia).
January 31, 2017
ava ilable at
journal homepage:
DOIs of original articles: , .
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.