Local and systemic therapy for patients with metastatic prostate cancer: Should the primary tumor be treated?

Canby-Hagino, Edith; Swanson, Gregory P.; Crawford, E. David; Basler, Joseph W.; Hernández, Javier; Thompson, Ian M.

doi:10.1007/s11918-005-0009-1

Cited by 4 publications

(5 citation statements)

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“…Adoption of local therapy in other metastatic cancers has brought us ideas to explore its value in metastatic prostate cancer. However, some studies previously claimed that if the tumor had spread across the capsule of the prostate, definitive local therapy to the tumor could not control the development of tumor or improve prognosis, but only alleviate local symptoms ( 20 , 21 ). Therefore, definitive local therapy is rarely considered as a conventional treatment method in prostate cancer management ( 3 , 5 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Local Treatment in Prostate Cancer Patients With Different Metastatic Sites: A Population Based Retrospective Study

et al. 2020

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PurposeOur study aims to examine the impact of definitive local therapy in prostate cancer patients with different metastatic sites.MethodsTotally, 5,849 patients diagnosed with metastatic prostate carcinoma from 2010 to 2014 were selected from Surveillance, Epidemiology, and End Results (SEER). Log-rank analyses, multivariable regression analysis, and Kaplan–Meier methods were used to assess prognostic impact of local treatment in patients with different metastatic sites. Survival curves and forest plots were also plotted to describe the prognostic value of definitive local therapy.ResultsIn our study, 159 patients received radical prostatectomy, and 62 received brachytherapy, while 5,628 did not receive local definitive local therapy. Survival analysis revealed that patients who received definitive local therapy had a better 5-year overall survival (OS) (P = 0.011) and cancer-specific survival (CSS) (P = 0.012). Multivariate regression analyses demonstrated that type of treatment was an independent prognostic indicator for OS (P = 0.011) and CSS (P = 0.012), along with age at diagnosis, chemotherapy, PSA level, and Gleason score. According to subgroup analysis, patients with bone metastasis or distant lymph node (LN) metastasis were significantly more likely to benefit from definitive local therapy. In addition, forest plots demonstrated that RP group had significant favorable OS and CSS in subgroups of younger age at diagnosis, T2–3 stage, N0–1 stage, Gleason score =7 or ≥8, bone metastasis, and distant LN metastasis.ConclusionsOur study suggested that local therapy improved survival in prostate cancer patients with bone or distant LN metastasis. Furthermore, patients who were at T2–3 stage or Gleason score ≥7 also significantly benefit from definitive local therapy.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Local Treatment in Prostate Cancer Patients With Different Metastatic Sites: A Population Based Retrospective Study

et al. 2020

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“…Â îêðåìèõ âèïàäêàõ öå ïîòðåáóº ïàë³àòèâíîãî õ³ðóðã³÷íîãî ë³êóâàííÿ. ×àñòîòà ïðèâåäåíèõ óñêëàäíåíü ìîaeå áóòè ïîâ'ÿçàíà ç â³äñóòí³ñòþ àê-òèâíî¿ ëîêàëüíî¿ òåðàï³¿ ï³ä ÷àñ ïîïåðåäí³õ ñòàä³é çàõâîðþâàííÿ, òîáòî, ëîêàë³çîâàíîãî ðàêó ïðîñòàòè [14,15]. ²ñíóº íàóêîâà ã³ïîòåçà, ùî íåêîíòðîëüîâàíå ëîêàëüíå çàõâîðþâàííÿ º äaeåðåëîì öèðêóëþ-þ÷èõ ïóõëèííèõ êë³òèí, ùî ñïðîìîaeí³ âèêëèêàòè ìåòàñòàçóâàííÿ îíêîëîã³÷íî¿ õâîðîáè òà íàâ³òü ðåêîëîí³çóâàòè ïåðâèííó ïóõëèíó á³ëüø àãðåñèâíèìè ³ ãîðìîí-ðåçèñòåíòíèìè êëîíàìè [12,16].…”

Section: ðåçóëüòàòè òà ¯õ îáãîâîðåííß Results and Discussionunclassified

“…Òàêèì ÷èíîì, øëÿõîì óñóíåííÿ ìîaeëèâîñò³ ï³äâèùåííÿ ãåòåðîãåííîñò³ ïóõëèíè ìè ìîaeåìî çá³ëüøèòè â³ðîã³äí³ñòü òðèâàëî¿ â³äïîâ³ä³ íà ñèñòåìíó òåðàï³þ â êîìá³íàö³¿ ç ïåðâèííèì ë³êóâàííÿì. Öå º ùå îäíèì äîêàçîì òîãî, ùî ïðîñòàòà º ôîêóñîì ðåçèñòåíòíîñò³ äî ñó÷àñíèõ ðå-aeèì³â ãîðìîíàëüíî¿ òåðàï³¿, ÿêà ñïðèÿº ïðèñêîðåííþ ïóõëèííî¿ ïðîãðåñ³¿ [14,19,31].…”

Section: ðåçóëüòàòè òà ¯õ îáãîâîðåííß Results and Discussionunclassified

“…ßêùî ìåòîäîì âèáîðó º õ³ðóðã³÷íà ìîäàëüí³ñòü, ïåðâèííå âîãíèùå ïîâèííî áóòè âèëó÷åíî ç âèñîêîþ â³ðîã³äí³ñòþ â³äñóòíîñò³ ïîçèòèâíîãî õ³ðóðã³÷íîãî êðàþ. ßêùî ìàº ì³ñöå ì³ñöåâîïîùèðåíèé ðàê ïðîñòàòè, íåîáõ³äíî ïðîâîäèòè íåîàä'þâàíòíó òåðàï³þ ç íàñòóïíèì âèáîðîì òàêòèêè ëîêàëüíîãî ë³êóâàííÿ (ðàäèêàëü-íî¿ ïðîñòàòåêòîì³¿ àáî òàðãåòíî¿ ïðîìåíåâî¿ òå-ðàï³¿) [14].…”

Section: ðåçóëüòàòè òà ¯õ îáãîâîðåííß Results and Discussionunclassified

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Modern approaches to local treatment of metastatic prostate cancer (literature review)

Головко¹,

Головко²

2021

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The potential oncological benefit of modern technological, laboratorial and imaging studies significantly improved disease-free survival rates in patients suffering from prostate cancer (PCa). Systematic reviews carried out in men with metastatic prostate cancer (mPCa) identify plenty of studies, especially dedicated to local treatment options. Unfortunately, young and fit patients with mPCa at diagnosis present unexpected resistance towards proposed treatment. Oncological outcomes demonstrate high rate of cancer-specific and overall mortality with precursory invasion of adjacent structures and impaired quality of life in patients. Current literature review was carried out using mainly PubMed and SciELO database to identify and analyze advances of local treatment of mPCa. The most relevant articles included studies performed from March 2005 to November 2020. According to the last brief reviews, main indication for providing primary treatment of PCa includes nonmetastatic PCa. Additionaly, it may be performed as palliative treatment for mPCa to minimize local invasion, prevent arising of new metastasis and provide better biological answer of chemotherapy and hormonal treatment. Recent data suggests that local treatment and overall survival turned out to be more effective in patients under 70 years. Thus, independent negative prognostic factors mentioned in patients with mPCa are age above 70 years, cT4 stage or high-grade disease, PSA і 20 ng/ml, and pelvic lymphadenopathies. While comparing patients who underwent local treatment with those one who did not, the presence of these 3 or more CSS and OS factors conditions remains the same. Metastasis degree and location number can also influence outcome. Furthermore, visceral metastases lead to worse prognosis. Exploring new treatment options for mPCa awoke interest in scientists in recent years. Radical prostatectomy and target radiation therapy remain the most effective in achieving local disease control and, thus, control of systemic disease. There is growing evidence supporting local treatment in cases of metastatic prostate cancer at diagnosis in the context of a multimodal approach. However, its oncological effect requires prospective studies with well-defined patient selection criteria. Prospective multicentric studies might sustain the existing data and define the main indications for primary treatment in mPCa.

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“…However, some studies have reported opposite findings. Once the tumor grows beyond the prostate capsule, removal of the PCa does not improve the survival outcomes, but rather, merely alleviates local symptoms and promotes psychological comfort [8][9][10][11]. The way by which appropriate therapies are selected for mPCa remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Survival outcomes for metastatic prostate cancer patients treated with radical prostatectomy or radiation therapy —— A SEER based study

Kusaka¹,

Qiu²,

Zhang³

et al. 2019

Preprint

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Background Patients appeared as metastatic prostate cancer (mPCa) have a very low 5-year-survival rate. How to choose proper treatment of mPCa remained controversial.Method Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015), we performed analyses of cancer specific mortality (CSM) and overall mortality (OM) in the comparisons of local treatment (LT) vs no local treatment (NLT) and radical prostatectomy (RP) vs radiation therapy (RT). To balance the characteristics between two treatment groups, propensity score matching were performed. Considering the selection bias, we additionally used an instrument variate (IVA) to calculate the unmeasured confounders.Result Our study selected mPCa patients with average age more than 60 yr, high level of PSA, and tend to present as high GS. Multivariate regression showed that patients received LT had the lower risks of OM and CSM after adjustment of covariates (HR=0.39, 95% CI 0.35-0.44 and HR=0.39, 95% CI 0.34-0.45). In the IV-adjusted model, LT showed more survival benefits compared with NLT, with hazard ratios of 0.57 (95% CI 0.50-0.65) and cancer specific hazard ratios of 0.59 (95% CI 0.51-0.68), respectively. For those received LT, adjusted multivariate regression indicated that RP is superior to RT, (HR=0.60 [95% CI 0.43-0.83] for OM and HR=0.61 [95% CI 0.42-0.91] for CSM). The IV-adjusted model also showed that RP presented with potentially better survival outcome compared with RT, although the effect was not statistically significant (HR=0.63 [95% CI 0.26-1.54] for OM and HR=0.47 [95% CI 0.16-1.35] for CSM).Conclusion Among patients with metastatic prostate cancer, local treatment might bring better survival benefits in decreasing cancer-specific mortality and all-cause mortality compared with non-local treatment. For those received LT, radical prostatectomy showed better survival outcomes than radiation therapy.

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Local and systemic therapy for patients with metastatic prostate cancer: Should the primary tumor be treated?

Cited by 4 publications

References 45 publications

Prognostic Value of Local Treatment in Prostate Cancer Patients With Different Metastatic Sites: A Population Based Retrospective Study

Prognostic Value of Local Treatment in Prostate Cancer Patients With Different Metastatic Sites: A Population Based Retrospective Study

Modern approaches to local treatment of metastatic prostate cancer (literature review)

Survival outcomes for metastatic prostate cancer patients treated with radical prostatectomy or radiation therapy —— A SEER based study

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