Tumor cytoreduction results in better response to androgen ablation—a preliminary report of palliative transurethral resection of the prostate in metastatic hormone sensitive prostate cancer

Xiao, Qiong; Guang, Chun; Ye, Ding Wei; Yao, Xu; Zhang, Shi Lin; Dai, Bo; Zhang, Hai Liang; Shen, Yi; Zhu, Yao; Zhu, Yi Ping; Shi, Guo Hai; Xiao, Weizhong; Lin, Guorong; Swanson, Gregory P.

doi:10.1016/j.urolonc.2010.02.010

Cited by 50 publications

(34 citation statements)

References 20 publications

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“…Some 24%-44% of men treated for prostate cancer with noncurative intent will develop symptomatic local progression requiring intervention(34, 35). Moreover, retrospective studies suggest that control of the primary tumor may improve the outcome of men with metastatic disease (36), a fact borne out in randomized trials in men with locally advanced prostate cancer (37, 38), which is in line with observations in other tumor types (39, 40). These data may justify applying consolidative definitive treatment to the primary tumor despite the presence of distant metastases in this patient population.…”

Section: Discussionsupporting

confidence: 61%

Platinum-Based Chemotherapy for Variant Castrate-Resistant Prostate Cancer

Aparicio

Harzstark

Corn

et al. 2013

Clinical Cancer Research

361

384

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Purpose Clinical features characteristic of small-cell prostate carcinoma (SCPC), (““anaplastic””) often emerge during the progression of prostate cancer. We sought to determine the efficacy of platinum-based chemotherapy in patients meeting at least one of seven prospectively defined “anaplastic” clinical criteria, including exclusive visceral or predominantly lytic bone metastases, bulky tumor masses, low PSA levels relative to tumor burden or short response to androgen deprivation therapy. Experimental Design A 120-patient phase II trial of frontline carboplatin and docetaxel (CD) and second-line etoposide and cisplatin (EP) was designed to provide reliable clinical response estimates under a Bayesian probability model with early stopping rules in place for futility and toxicity. Results Seventy-four of 113 (65.4%) and 24 of 71 (33.8%) were progression free after 4 cycles of CD and EP, respectively. Median overall survival (OS) was 16 months (95% CI, 13.6-19.0 months). Of the 7 “anaplastic” criteria, bulky tumor mass was significantly associated with poor outcome. Lactic acid dehydrogenase (LDH) strongly predicted for OS and rapid progression. Serum carcinoembryonic antigen (CEA) concentration strongly predicted OS but not rapid progression. Neuroendocrine markers did not predict outcome or response to therapy. Conclusion Our findings support the hypothesis that patients with “anaplastic” prostate cancer are a recognizable subset characterized by a high response rate of short duration to platinum-containing chemotherapies, similar to SCPC. Our results suggest that CEA is useful for selecting therapy in men with CRPC and consolidative therapies to bulky high-grade tumor masses should be considered in this patient population.

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Section: Discussionsupporting

confidence: 61%

Platinum-Based Chemotherapy for Variant Castrate-Resistant Prostate Cancer

Aparicio

Harzstark

Corn

et al. 2013

Clinical Cancer Research

361

384

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“…Control patients who did not receive TURP were more likely to develop hormone-refractory PCa (p = 0.007). For the data published thus far, there is no significant difference in disease-specific survival or OS between the groups [19]. These studies suggest[ 1 1 _ T D $ D I F F ] treating the primary tumor in mPCa has a plausible role; however, further research in humans is warranted to discern appropriate candidates for local therapy.…”

Section: Tumor Debulkingmentioning

confidence: 90%

“…Grinis et al [18] also found a significant decrease in metastatic lung lesions in mice treated with resection of the primary lesion, further establishing a preclinical model incorporating local therapy. In a clinical setting, Qin et al [19] investigated patients with hormone-sensitive mPCa treated with ADT with and without transurethral resection of the prostate (TURP) as a symptom-relieving procedure. Preliminary results [ 1 0 1 _ T D $ D I F F ] showed patients who underwent TURP had a significantly lower PSA nadir (median 0.15 vs 0.82 ng/ml, p = 0.015) and a longer time to PSA nadir (11.2 vs 6.4 mo, p < 0.001).…”

Section: Tumor Debulkingmentioning

confidence: 99%

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

et al. 2016

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“…Despite the extensive pretreatment, all RP specimens contained vital cancer cells with biologically lethal properties, as assessed by immunohistochemistry of various biomarkers implicated in disease progression and therapy resistance. These data at least raise the suspicion that persisting intraprostatic cancer foci may be involved in local progression and the development of systemic metastases [9,10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

The Role of Palliative Surgery in Castration-Resistant Prostate Cancer

Heidenreich

Porres²,

Pfister³

2015

Oncol Res Treat

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Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone (LHRH) analogues or antagonists represents the treatment of choice in men with metastatic prostate cancer (PCA). Depending on the serum concentration of the prostate-specific antigen (PSA) nadir, the survival might vary between 11 and 78 months. In castration-resistant PCA (CRPC), all new medical treatment options can induce complete and partial remissions in metastatic foci, but they have no profound effect on the prostate itself, as has been shown recently. About one-third of all patients without local treatment of the primary will develop significant complications of the lower and upper urinary tract due to local progression of the PCA. In men with CRPC and lower urinary tract symptoms, palliative transurethral resection of the prostate (TURP) can be performed with a 60-70% success rate. Infiltration of the pelvic floor, the bladder neck and trigone, and the external urethral sphincter can make palliative radical surgery necessary. Bladder neck closure with continent vesicostomy, radical cystoprostatectomy with an incontinent urinary diversion, and anterior and posterior exenteration are individual therapeutic options in men with a good performance status and a considerable life expectancy. Symptomatic involvement of the upper urinary tract can be managed by the placement of endoluminal stents or a percutaneous nephrostomy in men with poor performance. In men with a good response to ADT and a good performance status, reconstructive ureteral surgery might be considered and the options of ureteral reimplantation, ureter ileal replacement, and a subcutaneous pyelovesical bypass have to be discussed. The indication to perform one of the above-mentioned surgical approaches needs to be discussed in a multidisciplinary tumor board.

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Tumor cytoreduction results in better response to androgen ablation—a preliminary report of palliative transurethral resection of the prostate in metastatic hormone sensitive prostate cancer

Cited by 50 publications

References 20 publications

Platinum-Based Chemotherapy for Variant Castrate-Resistant Prostate Cancer

Platinum-Based Chemotherapy for Variant Castrate-Resistant Prostate Cancer

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

The Role of Palliative Surgery in Castration-Resistant Prostate Cancer

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