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Morozov A, Chuvalov L, Taratkin M, Enikeev M, Rapoport L, Singla N, Barret E, Poddubskaya E, Borodina M, Salomon G, Rivas JG, Enikeev D. A systematic review of cytoreductive prostatectomy outcomes and complications in oligometastatic disease. Asian J Urol 2024; 11:208-220. [PMID: 38680575 PMCID: PMC11053306 DOI: 10.1016/j.ajur.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space. Methods We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results. Results In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%. Conclusion CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Chuvalov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Young Academic Urologists, EAU, the Netherlands
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Maria Borodina
- Hertsen Moscow Oncology Research Institute, Moscow, Russia
| | - Georg Salomon
- Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Tian Y, Mao Y, Tang Z, Hu M. Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer. Technol Cancer Res Treat 2023; 22:15330338231216011. [PMID: 38105493 PMCID: PMC10729631 DOI: 10.1177/15330338231216011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Oligometastatic prostate cancer is a term that is most often used to refer to limited sites of disseminated tumor growth following primary radical prostatectomy (RP) or radiotherapy (RT), while de novo oligometastatic is a term that is used to refer to prostate tumors that have disseminated to limited sites before definitive treatment. In patients with de novo oligometastatic prostate cancer, treatment planning must thus consider the need to manage the primary tumor and the associated distant lesions. Traditionally, resectioning primary metastatic tumors is not thought to offer significant benefits to affected patients while increasing their risk of surgery-related complications. Recent clinical evidence indicates that patients undergoing cytoreductive prostatectomy (CRP) may observe substantial enhancements in overall survival rates while not experiencing a noticeable decline in their quality of life. Nevertheless, based on the current body of evidence, it is deemed inadequate to justify revising clinical guidelines. Consequently, it is not advisable to propose CRP for patients with oligometastatic prostate cancer. The present review was compiled to summarize available data regarding the indications, functional outcomes, and oncological outcomes associated with cytoreductive radical prostatectomy to provide a robust and objective foundation that can be used to better assess the value of this interventional strategy from a clinical perspective.
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Affiliation(s)
- Yuan Tian
- Maoming People's Hospital, Maoming, Guangdong, China
- The First School of Clinical Medicine, Southern Medical University, Gaungzhou, China
| | - Yifeng Mao
- The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Zhizhong Tang
- Maoming People's Hospital, Maoming, Guangdong, China
| | - Mingqiu Hu
- Maoming People's Hospital, Maoming, Guangdong, China
- The First School of Clinical Medicine, Southern Medical University, Gaungzhou, China
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3
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Song M. Influence of a continuous nursing model based on network cloud platforms for urinary control, urination function and quality of life of patients after radical prostatectomy. Am J Transl Res 2021; 13:5356-5361. [PMID: 34150130 PMCID: PMC8205771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of a continuous nursing mode on urinary control, urinary function and quality of life of patients after radical prostatectomy under the network cloud platform. METHOD A total of 100 prostate cancer patients admitted to our hospital from January 2017 to January 2019 were enrolled. According to different care modes, they were divided into the experimental group and the control group, 50 patients in each group. Patients in the experimental group received the continuous care model under the network cloud platform, and the control group patients received the conventional care model. Urinary control, urination, self-care ability, incidence of complications, quality of life and nursing satisfaction of the two groups were compared. RESULTS In terms of urination, urinary control, quality of life, self-care ability, the incidence of complications and nursing satisfaction, the experimental group was better than the control group (P<0.05). CONCLUSION The continuous nursing model under the network cloud platform has a positive impact on patient's urinary control, urination function and quality of life after radical prostatectomy. It is worthy of being widely promoted and used in clinical treatment.
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Affiliation(s)
- Miaomiao Song
- Department II of Urological Surgery, Cangzhou Central Hospital Cangzhou, China
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Xue P, Wu Z, Wang K, Gao G, Zhuang M, Yan M. Oncological Outcome of Combining Cytoreductive Prostatectomy and Metastasis-Directed Radiotherapy in Patients with Prostate Cancer and Bone Oligometastases: A Retrospective Cohort Study. Cancer Manag Res 2020; 12:8867-8873. [PMID: 33061582 PMCID: PMC7520542 DOI: 10.2147/cmar.s270882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/04/2020] [Indexed: 01/06/2023] Open
Abstract
Background The current standard of care for metastatic prostate cancer (mPCa) is androgen deprivation therapy (ADT) with or without anti-androgen and chemotherapy. The aim of this study was to evaluate the efficacy and safety of a multimodal approach including local primary tumor therapy, metastasis-directed therapy (MDT), and hormonal therapy in patients with oligometastatic prostate cancer (PCa). Methods We reviewed data of patients with PCa and bone oligometastases at diagnosis treated in three institutions with ADT followed by cytoreductive surgery with or without metastases-directed radiotherapy. Oligometastases were defined as the presence of five or fewer metastatic lesions with the absence of visceral metastases. In this retrospective cohort study, 58 patients underwent cytoreductive radical prostatectomy and ADT. Of these, 26 patients (45%) received stereotactic body radiation therapy (SBRT) to all metastatic sites as a MDT. Oncological outcomes were analyzed using the Kaplan–Meier method. Results The median follow-up period was 46.2 months. Of the 58 patients, the 3-year castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival was 75.9% and 91.4%, respectively. Pre- or post-treatment predictive factors for progression to CRPC, including prostate-specific antigen (PSA) level at diagnosis ≥20 ng/mL, Gleason grade groups 5, clinical T stage cT3b-4, PSA nadir level of ≥0.05 ng/mL, and no MDT with SBRT, were significantly associated with progression to CRPC. Subgroup analysis showed that the MDT group had significantly better CRPC-free survival than the non-MDT group with Gleason grade groups 1–4 (HR=0.228; 95% CI= 0.056–0.926). A total of 3.4% of the patients had grade 2 acute genitourinary toxicities and 5.2% had grade 2 acute gastrointestinal toxicities. No late grade >2 adverse events were observed. Conclusion This multi-center, retrospective cohort study revealed the feasibility of combining cytoreductive prostatectomy and metastasis-directed radiotherapy for newly-diagnosed oligometastatic PCa. This treatment strategy has the potential to delay the progression to CRPC.
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Affiliation(s)
- Peng Xue
- Department of Urology, First People Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Ziyu Wu
- Department of Urology, NO 2 Hospital of Huaian, Huaian, Jiangsu Province, People's Republic of China
| | - Kunpen Wang
- Department of Urology, First People Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Guojun Gao
- Department of Urology, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong Province, People's Republic of China
| | - Min Zhuang
- Department of Oncology, First People Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Miao Yan
- Department of Oncology, First People Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
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Lan T, Chen Y, Su Q, Ye J. Oncological Outcome of Cytoreductive Radical Prostatectomy in Prostate Cancer Patients With Bone Oligometastases. Urology 2019; 131:166-175. [PMID: 31181273 DOI: 10.1016/j.urology.2019.03.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore the role of cytoreductive radical prostatectomy (CRP) for locally resectable and distant oligometastatic prostate cancer (CaP). PATIENTS AND METHODS Oligometastases were defined as the presence of 5 or fewer metastatic lesions detected on 99mTc bone scan and no suspicious visceral involvement at pretreatment imaging. Clinical data on 111 consecutive patients who were diagnosed as oligometastatic CaP in our center from 2005 to 2016 was retrospectively collected. In this retrospective cohort study, 35 patients underwent CRP and androgen deprivation therapy, and 76 patients underwent androgen deprivation therapy alone. Oncological outcomes were analyzed by employing Kaplan-Meier method. RESULTS The median follow-up of both groups was 35 months. In whole cohort analyses, prostate-specific antigen (PSA) decrease velocity (P = .167), PSA half-time (P = .263), and PSA nadir (P = .196) were not significantly different between 2 groups. Meanwhile, the differences in oncological outcomes between 2 groups did not reach statistical significance with regard to PSA relapse-free survival (P = .184), clinical progression-free survival (P = .118), and cancer-specific survival (P = .773). In addition, similar results were also observed in prespecified subgroup analyses (lower PSA group [0-100 ng/mL, P = .543], lower Gleason score group [6-7, P = .266], lower clinical T stage group [2-3 stage, P = .962], lower radiological N stage group [0 stage, P = .364]). CONCLUSION In our study, significant benefit from CRP has not been detected in patients with oligometastatic CaP. Facing current trend, it demands deliberate consideration to select candidates for cytoreductive surgery, and the selection criteria should be further refined by incorporating additional prognostic factors.
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Affiliation(s)
- Tian Lan
- Department of Urology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China
| | - Ye Chen
- Department of Surgery and Anesthesiology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China.
| | - QinJun Su
- Department of Pathology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China
| | - JianJun Ye
- China Department of Medical Imaging, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China
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Sow Y, Sow O, Fall B, Sine B, Sarr A, Zé Ondo C, Diao B, Ndoye AK, Ba M. Impact of tumor cytoreduction in metastatic prostate cancer. Res Rep Urol 2019; 11:137-142. [PMID: 31192170 PMCID: PMC6511624 DOI: 10.2147/rru.s204507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/07/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the impact of tumor cytoreduction on cancer outcomes and patient survival in metastatic prostate cancer. Patients and methods: It is a prospective study spanning a two-year period between October 1st 2015 and March 31st 2017. We enrolled 102 cases of metastatic hormone-sensitive prostate cancer. Fifty-seven (57) patients had exclusively androgen deprivation therapy (ADT) (group 1) and 45 had, in addition, an open prostatectomy or Transurethral resection of the Prostate (group 2). We compared both groups using the total PSA nadir, the time to PSA nadir, the overall survival (OS), and the progression-free survival (PFS). Results: The average nadir PSA was lower for the tumor cytoreduction group (16.8±1.6 ng/mL (0.01-193.5) versus 110.7±17.9 ng/mL (0.01-1379)). Median time to PSA nadir was shorter in patients in the ADT only group (8 months vs 3 months (p=0.025)). The OS was shorter in patients treated with ADT only compared to the tumor cytoreduction group (median 14 months vs 24 months, respectively (p=0.03)). Similarly, tumor cytoreduction had a positive impact on patient progression (median PFS 20 months (group 1) vs 43 months (group 2)). Conclusion: Tumor cytoreduction has a positive impact on the oncological results and the survival of patients under ADT.
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Affiliation(s)
- Yaya Sow
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Ousmane Sow
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Boubacar Fall
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Babacar Sine
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Alioune Sarr
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Cyrille Zé Ondo
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Babacar Diao
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Alain Khassim Ndoye
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Mamadou Ba
- Urology and Andrology Department at Aristide Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
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7
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Yuh BE, Kwon YS, Shinder BM, Singer EA, Jang TL, Kim S, Stein MN, Mayer T, Ferrari A, Lee N, Parikh RR, Ruel N, Kim WJ, Horie S, Byun SS, Ahlering TE, Kim IY. Results of Phase 1 study on cytoreductive radical prostatectomy in men with newly diagnosed metastatic prostate cancer. Prostate Int 2018; 7:102-107. [PMID: 31485434 PMCID: PMC6713798 DOI: 10.1016/j.prnil.2018.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 12/27/2022] Open
Abstract
Background Preclinical and retrospective data suggest that cytoreductive radical prostatectomy may benefit a subset of men who present with metastatic prostate cancer (mPCa). Herein, we report the results of the first planned Phase 1 study on cytoreductive surgery. Methods From four institutions, 36 patients consented to the study. However, four did not complete surgery because of rapid disease progression (n = 3) and another because of an intraoperatively discovered pericolonic abscess. Men with newly diagnosed clinical mPCa to lymph nodes or bones were eligible. The primary endpoint was the rate of major perioperative complications (Clavien-Dindo Grade 3 or higher) occurring within 90 days of surgery. Results The mean age at surgery was 64.0 years. The 90-day overall complication rate was 31.2% (n = 10), of which two (6.25%) were considered major complications: one acute tubular necrosis requiring temporary dialysis and one death. In men with more than 6 months of follow-up, 67.9% had prostate specific antigen nadir ≤0.2 ng/mL, while one patient experienced a rapid rise in prostate specific antigen and another a widely disseminated disease that resulted in death 5 months after surgery. Altogether, these results demonstrate that cytoreductive radical prostatectomy is safe and surgically feasible in selected patients who present with mPCa . Yet, there may be a small subset of patients in whom surgery may cause a significant harm. Conclusion Therefore, cytoreductive surgery in men with mPCa should be limited to clinical trials until robust data are available.
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Affiliation(s)
- Bertram E Yuh
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Young Suk Kwon
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Brian M Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sinae Kim
- Department of Biostatistics, Rutgers School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | - Mark N Stein
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Tina Mayer
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Anna Ferrari
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Nara Lee
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Nora Ruel
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Thomas E Ahlering
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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8
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Heidenreich A, Fossati N, Pfister D, Suardi N, Montorsi F, Shariat S, Grubmüller B, Gandaglia G, Briganti A, Karnes RJ. Cytoreductive Radical Prostatectomy in Men with Prostate Cancer and Skeletal Metastases. Eur Urol Oncol 2018; 1:46-53. [PMID: 31100228 DOI: 10.1016/j.euo.2018.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/03/2018] [Accepted: 03/14/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) represents the standard treatment for hormone-naïve prostate cancer with systemic metastases (mPCA). The role of radical prostatectomy (RP) in this setting is unclear. OBJECTIVE To evaluate the oncological and functional outcomes of men with mPCA who underwent cytoreductive RP (CRP). DESIGN, SETTING, AND PARTICIPANTS Retrospective, multi-institutional study of 113 patients with biopsy-proven mPCA who fulfilled the following selection criteria: (1) completely resectable PCA; (2) osseous metastases; (3) absence of gross retroperitoneal lymph node metastases; (4) absence of bulky pelvic lymph node metastases >3cm; (5) no or minimal visceral metastases; (6) Eastern Cooperative Oncology Group performance status of 0-1; and (7) written informed consent. INTERVENTION CRP with extended pelvic lymphadenectomy. Eighty patients (70.8%) received neoadjuvant ADT and 91 (86.5%) adjuvant ADT and/or radiation therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer-specific survival, overall survival (OS), biochemical relapse-free survival (BRFS), and clinical relapse-free survival (CRFS) were evaluated using descriptive statistical analyses, the Kaplan-Meier method, and univariate and multivariate analyses. Treatment-associated complications were analysed according to the Clavien-Dindo classification. RESULTS AND LIMITATIONS The mean patient age was 61 yr (range 42-69). The mean follow-up was 53.6 mo (range 13-96, median 45.7). The 3-yr and 5-yr OS was 99 (87.6%) and 90 (79.6%), respectively, and the mean CRFS was 72.3 mo. Preoperative prostate-specific antigen (PSA)<1.0ng/ml and PSA below the median of 8.0ng/ml were significantly associated with BRFS (p<0.0004). Pathohistology revealed viable PCA in all cases: 16 (14.2%) had pT4a, 21 (18.6%) had pT2a-c, and 76 (67.3%) had pT3a/b PCA. Positive lymph nodes were identified in 61.6% and positive surgical margins in 36.8% of the patients. Eleven men (9.7%) experienced Clavien Dindo grade IIIa-b complications. Low-volume disease, neoadjuvant ADT, and preoperative PSA were significantly associated with a lower risk of surgery-related complications (p<0.05). No, mild (1-2 pads/d), and severe incontinence (>2 pads/d) was observed in 68.1%, 17.7%, and 14.1%, respectively. Limitations of the study are the retrospective nature and potential patient selection bias. CONCLUSIONS CRP results in 5-yr OS of 80%, a low rate of significant complications, and good functional outcome in well-selected patients. CRP might be an individualised treatment option in the multimodal management of mPCA. PATIENT SUMMARY We assessed oncological and functional outcomes associated with cytoreductive radical prostatectomy (CRP) in select men with prostate cancer and osseous metastases. We found that CRP might be associated with long overall and relapse-free survival in well-selected patients. CRP could become an additional treatment option in the multimodal therapy of metastatic prostate cancer; it should be performed in a clinical protocol setting and does not represent a standard therapeutic option.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany; Department of Urology, University of Vienna, Vienna, Austria.
| | - Nicola Fossati
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany
| | - Nazareno Suardi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | | | | | - Giorgio Gandaglia
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
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9
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Reichard CA, Gregg JR, Achim MF, Aparicio AM, Pettaway CA, Pisters LL, Ward JF, Davis JW, Chapin BF. Radical Prostatectomy in Metastatic Castration-resistant Prostate Cancer: Feasibility, Safety, and Quality of Life Outcomes. Eur Urol 2018; 74:140-143. [PMID: 29656854 DOI: 10.1016/j.eururo.2018.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
Abstract
Ongoing prospective studies are evaluating treatment of the primary tumor in men with de novo metastatic prostate cancer (PCa). One potential benefit is prevention of morbidity from local progression. Thus, local therapy may be best applied selectively to men with local progression once resistance to first-line therapies has occurred. Here, we gather support for the hypothesis that radical prostatectomy (RP) is safe and preserves quality of life (QOL) when applied in men with metastatic castration-resistant PCa (mCRPC). We analyzed 14 patients who underwent RP in the setting of mCRPC from 2008 to 2016. Median time from mCRPC to RP was 5.1 mo (interquartile range [IQR] 1.4-12.0). Median preoperative and <3 mo postoperative Expanded Prostate Cancer Index Composite urinary function QOL scores were 84 (IQR 70-95) and 78 (IQR 62-81), respectively. There were one Clavien Grade III, three Grade II, and one Grade I complications postoperatively. In these patients with mCRPC, RP was feasible with limited minor complications. PATIENT SUMMARY We report on a select group of men with metastatic castration-resistant prostate cancer who had prostatectomy. Prostatectomy is highly investigational in this setting and should not be used outside of a clinical trial other than for symptom relief.
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Affiliation(s)
- Chad A Reichard
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Justin R Gregg
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mary F Achim
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ana M Aparicio
- Department of GU Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Curtis A Pettaway
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Louis L Pisters
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - John F Ward
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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