Radical prostatectomy in metastatic prostate cancer: is there enough evidence? | Opinion: Yes

Costa, Walter Henriques da; Guimarães, Gustavo Cardoso

doi:10.1590/s1677-5538.ibju.2016.05.04

Cited by 2 publications

(1 citation statement)

References 20 publications

(19 reference statements)

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“…As a result, selected patients could benefit from a lower risk of local complications, prolonged survival and reduced mortality [ 11 , 12 ]. However, in spite of the enthusiasm of cytoreductive surgery, whether it was equally feasible or beneficial in mPCa patients still remained controversial and the merits of such an approach should be carefully considered [ 13 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

The role of radical prostatectomy for the treatment of metastatic prostate cancer: a systematic review and meta-analysis

et al. 2018

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The recommended therapy by EAU guidelines for metastatic prostate cancer (mPCa) is androgen deprivation therapy (ADT) with or without chemotherapy. The role of radical prostatectomy (RP) in the treatment of mPCa is still controversial. Hence, a meta-analysis was conducted by comprehensively searching the databases PubMed, EMBASE and Web of Science for the relevant studies published before September 1st, 2017. Our results successfully shed light on the relationship that RP for mPCa was associated with decreased cancer-specific mortality (CSM) (pooled HR = 0.41, 95%CI = 0.36–0.47) and enhanced overall survival (OS) (pooled HR = 0.49, 95%CI = 0.44–0.55). Subsequent stratified analysis demonstrated that no matter how RP compared with no local therapy (NLT) or radiation therapy (RT), it was linked to a lower CSM (pooled HR = 0.36, 95%CI = 0.30–0.43 and pooled HR = 0.56, 95%CI 0.43–0.73, respectively) and a higher OS (pooled HR = 0.49, 95%CI = 0.44–0.56 and pooled HR = 0.46, 95%CI 0.33–0.65, separately). When comparing different levels of Gleason score, M-stage or N-stage, our results indicated that high level of Gleason score, M-stage or N-stage was associated with increased CSM. In summary, the outcomes of the present meta-analysis demonstrated that RP for mPCa was correlated with decreased CSM and enhanced OS in eligible patients of involved studies. In addition, patients with less aggressive tumors and good general health seemed to benefit the most. Moreover, no matter compared with NLT or RT, RP showed significant superiority in OS or CSM. Upcoming prospective randomized controlled trials were warranted to provide more high-quality data.

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