Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H



STAMPEDE arm H demonstrated a survival benefit for newly diagnosed prostate cancer (PCa) patients with low metastatic burden (LMB) who additionally received radiotherapy (RT) to the primary. However, it is unknown if radical prostatectomy (RP) may achieve equivalent results, since existing studies did neither include the same selection criteria nor examine comparable endpoints as STAMPEDE arm H.


We retrospectively analysed 78 RP patients (2008–2018) with LMB (< 4 bone metastases) as defined in the subgroup analysis of STAMPEDE arm H. Like in STAMPEDE, overall (OS), metastatic progression-free (MPFS), and PCa-specific (CSS) survival at 3 years, as well as complication and continence rates were assessed.


Median age was 64 years. Median follow-up was 36 months. Median initial prostate-specific antigen was 35 ng/ml. At 3 years, OS was 91%, MPFS was 63%, and CSS was 92%, while 81%, 67%, and 86%, respectively, were reported in the RT subgroup with LMB in STAMPEDE arm H. Clavien-Dindo grade III–IV complications were observed in 16 (21%) patients. Of 38 patients with available continence data, 28 (74%) patients were continent and 2 (5%) patients needed ≥ 3 pads/day at 1 year after RP.


When comparing our RP cohort with the results of STAMPEDE arm H with LMB who received RT, no major disadvantage in OS and CSS may be expected. Since local treatment in patients with LMB might now be considered the new standard, RP should be further explored as local treatment option in these patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Liu W, Laitinen S, Khan S, Vihinen M, Kowalski J, Yu G et al (2009) Copy number analysis indicates monoclonal origin of lethal metastatic prostate cancer. Nat Med 15(5):559–565

    CAS  Article  Google Scholar 

  2. 2.

    Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A et al (2018) Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet Lond Engl 392:2353–2366

    Article  Google Scholar 

  3. 3.

    Tilki D, Pompe RS, Bandini M, Marchioni M, Kretschmer A, Tian Z et al (2018) Local treatment for metastatic prostate cancer: a systematic review. Int J Urol Off J Jpn Urol Assoc 25(5):390–403

    Google Scholar 

  4. 4.

    Heidenreich A, Pfister D, Porres D (2015) Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol 193(3):832–838

    Article  Google Scholar 

  5. 5.

    Heidenreich A, Fossati N, Pfister D, Suardi N, Montorsi F, Shariat S et al (2018) Cytoreductive radical prostatectomy in men with prostate cancer and skeletal metastases. Eur Urol Oncol 1(1):46–53

    Article  Google Scholar 

  6. 6.

    Sooriakumaran P, Karnes J, Stief C, Copsey B, Montorsi F, Hammerer P et al (2016) A multi-institutional analysis of perioperative outcomes in 106 men who underwent radical prostatectomy for distant metastatic prostate cancer at presentation. Eur Urol 69(5):788–794

    Article  Google Scholar 

  7. 7.

    Budäus L, Isbarn H, Schlomm T, Heinzer H, Haese A, Steuber T et al (2009) Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol 56(2):317–324

    Article  Google Scholar 

  8. 8.

    Schlomm T, Heinzer H, Steuber T, Salomon G, Engel O, Michl U et al (2011) Full functional-length urethral sphincter preservation during radical prostatectomy. Eur Urol 60(2):320–329

    Article  Google Scholar 

  9. 9.

    European Association Urology (2019) European Association of Urology Guidelines. 2019 Edition. [Internet]. European Association of Urology Guidelines Office, editor. Presented at the EAU Annual Congress Barcelona 2019. European Association of Urology Guidelines Office, Arnhem. http://uroweb.org/guidelines/compilations-of-all-guidelines/

  10. 10.

    Fröhner M, Khan C, Koch R, Schorr SG, Wirth M (2014) Implementation of the S3 prostate cancer guideline in daily clinical practice: results of a survey among urologists. Urol Ausg A 53(10):1500–1503

    Article  Google Scholar 

  11. 11.

    Protocol Amendment Pack [Internet]. STAMPEDE. [cited 2019 May 31]. http://www.stampedetrial.org/centres/protocol-amendment-pack/

  12. 12.

    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  Google Scholar 

  13. 13.

    Boevé LMS, Hulshof MCCM, Vis AN, Zwinderman AH, Twisk JWR, Witjes WPJ et al (2019) Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol 75(3):410–418

    Article  Google Scholar 

  14. 14.

    Impact of radical prostatectomy as primary treatment in patients with prostate cancer with limited bone metastases—full text view—ClinicalTrials.gov [Internet]. [cited 2019 Apr 24]. https://clinicaltrials.gov/ct2/show/NCT02454543

  15. 15.

    Leyh-Bannurah S-R, Gazdovich S, Budäus L, Zaffuto E, Briganti A, Abdollah F et al (2017) Local therapy improves survival in metastatic prostate cancer. Eur Urol 72(1):118–124

    Article  Google Scholar 

Download references

Author information




Protocol/project development: MG/SK. Data collection or management: SK, PM, BB, and PT. Data analysis: SK and PT. Manuscript writing/editing: SK, MG, DT, and TS.

Corresponding author

Correspondence to Sophie Knipper.

Ethics declarations

Conflict of interest

There was no external financial support for this study. The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Knipper, S., Beyer, B., Mandel, P. et al. Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H. World J Urol 38, 1459–1464 (2020). https://doi.org/10.1007/s00345-019-02950-0

Download citation


  • Overall survival
  • Local treatment
  • Oligometastatic prostate cancer
  • Radiotherapy