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

Abstract

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.

Nerve Growth Factor Induces Proliferation and Aggressiveness in Prostate Cancer Cells

“…Prostate cancer (PC) is the most commonly diagnosed non-cutaneous tumor in men and the second leading cause of male cancer-related deaths in Western society [1]. This cancer is often characterized by a slow and symptom-free growth, and early-stage treatments include radical prostatectomy, novel androgen receptor (AR) pathway inhibitors, such as abiraterone and enzalutamide, external beam radiotherapy (RT), brachytherapy and cryotherapy [2,3]. Further, use of new tracers for Positron Emission Tomography/Computed Tomography (PET/TC) [4,5,6,7] and novel focal therapies [8,9] have provided important advances in diagnosis, follow-up and treatment of PC patients in the last decade.…”

The cost of metastatic prostate cancer using time-driven activity-based costing

“…When the clinical variables and their relation to the total cost were evaluated, it was observed that patients who did not have their primary tumor treated previously had a higher risk of presenting the outcome (high cost). It is known that the local progression of PC may result in invasion of adjacent structures, urinary retention, hematuria (bladder invasion), intestinal obstruction, and fistulas (26). These are serious complications that demand hospital care, explaining the high cost in the group with no previous local treatment.…”

Risk factors of developing visceral metastases at diagnosis in prostate cancer patients

“…However, little attention has been focused on the risk factors and prognosis of atypical metastases including liver, brain, and lung metastases in stage IV PCa patients. Previous studies ( 1 , 7 - 9 ) reported that visceral involvement in PCa might be correlated to worse survival outcomes. The visceral metastatic site and frequency of occurrence were described based on a large population using SEER database.…”