<p>Impact of tumor cytoreduction in metastatic prostate cancer</p>

Abstract

Objective: To assess the impact of tumor cytoreduction on cancer outcomes and patient survival in metastatic prostate cancer. Patients and methods: It is a prospective study spanning a two-year period between October 1st 2015 and March 31st 2017. We enrolled 102 cases of metastatic hormone-sensitive prostate cancer. Fifty-seven (57) patients had exclusively androgen deprivation therapy (ADT) (group 1) and 45 had, in addition, an open prostatectomy or Transurethral resection of the Prostate (group 2). We compared both groups using the total PSA nadir, the time to PSA nadir, the overall survival (OS), and the progression-free survival (PFS). Results: The average nadir PSA was lower for the tumor cytoreduction group (16.8±1.6 ng/mL (0.01–193.5) versus 110.7±17.9 ng/mL (0.01–1379)). Median time to PSA nadir was shorter in patients in the ADT only group (8 months vs 3 months ( p =0.025)). The OS was shorter in patients treated with ADT only compared to the tumor cytoreduction group (median 14 months vs 24 months, respectively ( p =0.03)). Similarly, tumor cytoreduction had a positive impact on patient progression (median PFS 20 months (group 1) vs 43 months (group 2)). Conclusion: Tumor cytoreduction has a positive impact on the oncological results and the survival of patients under ADT.

Management of Advanced and Metastatic Prostate Cancer: A Need for a Sub-Saharan Guideline

“…In patients with advanced and metastatic prostate cancer, surgical and medical androgen deprivations were the commonest modalities offered [8–10, 12–15, 19, 21–23]. Yeboah et al [21] clearly emphasized the use of neoadjuvant hormonotherapy, androgen deprivation therapy, external beam radiation, brachytherapy, channeling TURP, and transurethral incision of the prostate as modalities in the management of patients reported for advanced and metastatic prostate cancer.…”

“…Androgen deprivation can be achieved using LHRH analogues, bilateral orchidectomy, or LHRH analogues + first-generation antiandrogen [2]. However, the STAMPEDE and CHAARTED trials have shown an overall survival benefit in high volume (mCNPC) receiving continuous androgen-ablation therapy and docetaxel (chemo-hormonotherapy) [23, 29, 31, 32]. Results from the STAMPEDE and LATITUDE studies also projected a greater median overall survival with abiraterone and prednisone in addition to androgen deprivation therapy for locally advanced and metastatic prostate cancer as compared to ADT alone [33, 34].…”

“…Most African literature studies [8–10, 12–15, 19, 21–23] have documented surgical castration by bilateral pulpectomy or orchidectomy as the preferred treatment option in patients with mCNPC. This approach is cost-effective as most patients in the region cannot afford medical ADT, but the approach remains irreversible.…”

“…Sow and colleagues [23] in Senegal evaluated 102 patients with metastatic hormone-sensitive prostate cancer and the patients were divided into two groups: one group received ADT alone by either medical or surgical castration while the other group received ADT + cytoreductive therapy in the form of either open prostatectomy or TURP. The results showed that patients receiving ADT + cytoreductive therapy had a better overall survival (median 24 months vs. 14 months, p =0.03) and progression-free survival (median 43 months (group 2) vs. 20 months (group 1)) as compared to those on ADT alone.…”

Cytoreductive radical prostatectomy or radiation therapy for metastases prostate cancer: Evidence from meta-analysis

“…The evidence level was relatively low, and our research found a clue that TURP could play an important role in metastatic PCa. [ 9 , 16 ]…”