A Multi-institutional Analysis of Perioperative Outcomes in 106 Men Who Underwent Radical Prostatectomy for Distant Metastatic Prostate Cancer at Presentation

Abstract

Men presenting with advanced prostate cancer that has spread beyond the prostate are increasingly being considered for treatments directed at the prostate itself. On the basis of results for our international series of 106 men, surgery appears reasonably safe in this setting for certain patients.

Survival Among Men at High Risk of Disseminated Prostate Cancer Receiving Initial Locally Directed Radical Treatment or Initial Androgen Deprivation Therapy

“…Owing to few surgical cases, it is not possible to compare radical modalities in this analysis. It is also not possible to investigate any possible benefit of surgery regarding palliation from pelvic pain, bladder outflow/ureteral obstruction, and hematuria [25,26], although we have previously shown radical prostatectomy to be safe and technically feasible in the metastatic setting [27].…”

Testing Radical prostatectomy in men with oligoMetastatic prostate cancer that has spread to the bone

“…We therefore compiled a cohort of 106 men from the United States, Germany, Italy, and Sweden who underwent radical prostatectomy for known newly diagnosed metastatic disease and found similar rates of re-operations, re-admissions, transfusions, and 21 specific complications as in our previous meta-analysis on 286,876 men after radical prostatectomy for standard indication 26 . These data have been recently published in European Urology 27 . Data supporting limiting the study to oligo-metastatic prostate cancer:…”

“…In other words, this is a conventional therapy being evaluated in an unconventional setting. There is no reason to suspect that the safety profile of radical prostatectomy will be different in oligo-metastatic disease than in localised or locally advanced prostate cancer, and we have published preliminary data to confirm its safety in a multiinstitutional cohort outside the UK 27 . However, we will collect Clavien-Dindo complications data and assess individual complications across all relevant domains for radical prostatectomy as per our prior publication 26 .…”

Treatment of the Primary Tumour in the Presence of Metastases: Lessons from Breast Cancer

“…A study by Fossati et al indicated that the largest benefit from local therapy may be obtained by patients with low-volume metastatic disease [8]; however, because their findings are also based on nonrandomised studies and thus are potentially biased, there seems to be no reason to exclude patients with extensive metastatic disease from trials, E U R O P E A N U R O L O G Y X X X ( 2 0 1 5 ) X X X -X X X provided that they are fit enough to undergo surgery and have a sufficiently long life expectancy. The study by Sooriakumaran et al, also published in this issue of European Urology, shows that radical prostatectomy appears to be safe when performed by experts and when used in carefully selected patients with stage M1 disease [9]. In their retrospective, international, and multicentre series of 106 patients, 80% suffered no complications, and only 1 patient had an intraoperative injury.…”