Primary treatment of the prostate improves local palliation in men who ultimately develop castrate‐resistant prostate cancer

Abstract

Objectives To determine whether local treatment of primary prostate cancer gives palliative benefit to men who later develop castrate‐resistant prostate cancer (CRPC). Local treatments of primary prostate cancer are defined as radical retropubic prostatectomy (RRP) or external beam radiation therapy (EBRT). Patients and Methods Patient records were reviewed in five different hospitals in Sydney, Australia, and 263 men with CRPC were identified. Eligible patients comprised men who had progressive disease during androgen deprivation therapy with castrate levels of testosterone. Clinical and pathological data were reviewed and evaluated using the chi‐squared test and relative risk analysis to determine the relationship between previous local prostate treatment and complications secondary to local disease. The end‐point was complications and morbidity attributed to cancer progression locally (i.e. from the prostate). Results Primary treatment of the prostate by either RRP or EBRT significantly reduces the incidence of local complications compared to no primary treatment (32.6% vs 54.6%; P = 0.001). RRP showed a significantly lower level of local complications compared to EBRT (20.0% vs 46.7%; P = 0.007). The most common local complications were bladder outlet obstruction (35.0%) and ureteric obstruction (15.2%). Conclusions The present retrospective analysis supports the hypothesis that primary local prostatic treatment gives palliative benefit to men who later develop CRPC. RRP was associated with the lowest local complication rate experienced at the stage of metastatic disease.

Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives

“…While this does not address the critical question of the degree of benefit, if any, of RT addition in this clinical scenario, these data serve as a basis for contemporary clinical guidelines One of the overriding hypotheses for local therapy of the primary tumor is that it may prevent or delay the onset of clinical symptoms from local progression. According to retrospective data for occult nodal disease, the incidence of symptomatic disease progression eventually requiring palliative surgical intervention is lower in patients who undergo initial RP than in those treated with systemic therapy alone [53][54][55]. Steinberg et al [53] reviewed 120 cases of node-positive PCa according to the modality of the initial treatment and local recurrence.…”

“…A more recent retrospective review of 192 cases of occult node-positive PCa treated with RP, RP and ADT, or ADT alone after PLND revealed a significantly lower incidence of symptomatic local relapse in men treated with RP and ADT (6.5%) versus RP or ADT alone (10.3% and 44.6%, respectively) [54]. In men with localized PCa who received local treatment and eventually progressed to castration-resistant PCa, 32.6% (20% treated with RP vs 46.7% treated with RT) eventually developed symptoms secondary to local disease progression or recurrence compared to 54.3% of men with intact primary tumors at the time of mPCa diagnosis [55]. Prostatic invasion of the ureters, bladder, or bladder outlet can result in incapacitating symptoms that significantly degrade a patient's quality of life in advanced disease.…”

Surgery in metastatic prostate cancer: a pilot study

“…4,5 Many men also suffer symptomatic disease progression and eventually require palliative surgical intervention, which is less frequent in those treated with initial radical prostatectomy compared to systemic therapy alone. 6,7 There are convincing data to support the concept of radical therapy in many metastatic cancers, including ovarian cancer, renal-cell carcinoma, glioblastoma, peritoneal carcinomatosis from gastrointestinal cancer, and colon cancer. 4 Hence, there is a rationale to examine whether it has a role in prostate cancer.…”

The Role of Palliative Surgery in Castration-Resistant Prostate Cancer

“…The M1 population, however, comprises a very heterogeneous group of patients with survival times varying between 11 and 75 months [3,4,5,6]. An updated, more precise classification of the Southwest Oncology Group (SWOG) 8894 trial has been published, which discriminates patients into 3 groups according to survival, with a median overall survival (OS) of 54, 30, and 21 months, respectively [4].…”

“…Due to this considerably long life expectancy even in men with CRPC, we might be faced with a higher frequency of complications of the lower and upper urinary tract due to progression of the prostate itself, local recurrences, and/or pelvic or retroperitoneal lymph node metastases. More than one-third of all patients without local treatment of the primary will develop significant complications of the urinary tract due to local progression of the PCA [6,7]. …”