Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense?

Mathiéu, Romain; Korn, Stephan; Bensalah, Karim; Kramer, Gero; Shariat, Shahrokh F.

doi:10.1007/s00345-016-1906-3

Cited by 23 publications

(23 citation statements)

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“…However, disappointing was no parallel increase had been seen in the overall survival (OS) or cancer-specific survival (CSS) among mPCa patients [ 17 ]. Thanks to the progresses in robotic-assisted radical prostatectomy (RP) and radiation therapy (RT) techniques, making the treatment of localized PCa be more safer and more effective, and paving the way for the treatment of mPCa [ 18 ]. Recently, by utilizing the aforementioned methods, Moschini et al had successfully demonstrated the feasibility of local surgical treatment of the primary tumor in mPCa patients.…”

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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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 primary treatment has been accepted and recommended in other metastatic malignancies with good morbidity and mortality outcomes [ 5 , 6 ].…”

Section: Resultsmentioning

confidence: 99%

Local Treatment of Metastatic Prostate Cancer: What is the Evidence So Far?

Almeida

Pereira

2018

Prostate Cancer

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Background Advances in technological, laboratorial, and imaging studies and new treatments available in the last decades significantly improved prostate cancer survival rates. However, this did not occur in metastatic prostate cancer (mPCa) at diagnosis which, in young and fit patients, will become invariably resistant to the established treatments. Progression will lead to an impairment in patients' quality of life and disease-related death. Methods The authors intend to perform a literature review of the advantages of primary treatment of mPCa. Articles were retrieved and filtered for relevance from PubMed, SciELO, and ScienceDirect until March 2017. Results Primary treatment is currently indicated only in cases of nonmetastatic PCa. Nonetheless, there might be some benefits in doing local treatment in mPCa in order to control local disease, prevent new metastasis, and improve the efficacy of chemotherapy and hormonotherapy with similar complications rate when compared to locally confined cancer. Independent factors that have a negative influence are age above 70 years, cT4 stage or high-grade disease, PSA ≥ 20 ng/ml, and pelvic lymphadenopathies. The presence of 3 or more of these factors conditions CSS and OS is the same between patients who performed local treatment and those who did not. Metastasis degree and location number can also influence outcome. Meanwhile, patients with visceral metastases have worse results. Conclusions There is growing evidence supporting local treatment in cases of metastatic prostate cancer at diagnosis in the context of a multimodal approach. However, it should be kept in mind that most of the existing studies are retrospective and it would be important to make consistent prospective studies with well-defined patient selection criteria in order to sustain the existing data and understand the main indications to select patients and perform primary treatment in mPCa.

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“…What appears clear is that the primary tumour is a continuous source of new metastases with its capability of promoting tumour progression. The primary site seems to be able to release tumour cells into the circulation, enriching itself (self-seeding) and promoting distant metastases [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive prostate radiotherapy in oligometastatic prostate cancer: a single centre analysis of toxicity and clinical outcome

Riva

Marvaso

Augugliaro

et al. 2017

ecancer

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ObjectivesThe current standard of care for patients with metastatic prostate cancer (mPCa) at diagnosis is androgen deprivation therapy (ADT) with or without anti-androgen and chemotherapy. The aim of this study was to define the role of a local radiotherapy (RT) treatment in the mPCa setting.MethodsWe retrospectively reviewed data of patients with PCa and bone oligometastases at diagnosis treated in our institution with ADT followed by cytoreductive prostate-RT with or without RT on metastases. Biochemical and clinical failure (BF, CF), overall survival (OS) and RT-toxicity were assessed.ResultsWe identified 22 patients treated with ADT and external-beam RT on primary between June 2008 and March 2016. All of them but four were also treated for bone metastases. RT on primary with moderately and extremely hypofractionated regimes started after 10.3 months (3.9–51.7) from ADT. After a median follow-up of 26.4 months (10.3–55.5), 20 patients are alive. Twelve patients showed BF after a median time of 23 months (14.5–104) and CF after a median of 23.6 months (15.3–106.1) from the start of ADT. Three patients became castration resistant, starting a new therapy; median time to castration resistance was 31.03 months (range: 29.9–31.5 months). According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC), only one patient developed acute grade 3 genitourinary toxicity. No late grade >2 adverse events were observed.ConclusionProstate RT in oligometastatic patients is safe and offers long-lasting local control. When compared to ADT alone, RT on primary seems to improve biochemical control and long-term survival; however, this hypothesis should be investigated in prospective studies. Further research is warranted.

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Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense?

Cited by 23 publications

References 50 publications

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

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

Local Treatment of Metastatic Prostate Cancer: What is the Evidence So Far?

Cytoreductive prostate radiotherapy in oligometastatic prostate cancer: a single centre analysis of toxicity and clinical outcome

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