Cytoreductive and Palliative Radical Prostatectomy, Extended Lymphadenectomy and Bilateral Orchiectomy in Advanced Prostate Cancer with Oligo and Widespread Bone Metastases: Result of a Feasibility, Our Initial Experience
Vol. 16 No. 2 (2019),
5 May 2019
purpose: to evaluate the feasibility of cytoreductive radical prostatectomy (RP), lymphadenectomy, and bilateral orchiectomy in patients with advanced prostate cancer (PCa) with oligo- and poly-metastases. Furthermore, the functional and oncological outcomes of these patients in comparison with the control group that underwent treatment only with systemic therapy (ST group) is investigated in a well-selected, prospective cohort study.
Material and methods: A total of 26 patients were enrolled in CRP (cytoreductive radical prostatectomy) group and 23 patients in ST group. The patients have been followed (9 to 43 months(median:19.5)) with PSA (prostate specific antigen), whole body bone scan and other necessary imaging and laboratory tests. Functional and oncological outcomes were compared between two groups.
Results: Biochemical relapse was occurred in 9 patients (34.6%) in CRP group and in 17 patients (73.9%) in ST group (p=0.01). Whole-body bone scans showed reduced metastasis volume occurred more in CRP group (p=0.003). There was no voiding dysfunction in 22 patients in CRP group post-operatively (84.6%), while in ST group trans-urethral resection of prostate or permanent Foley catheter was needed in 8 patients (34.7%) and bilateral percutaneous nephrostomy was done in one. six patients in CRP group (23%) and eight patients in ST group (34.7%) were expired because of prostate cancer and there was no difference between cancer specific survival between two groups (p=0.975).
Conclusion: Although surgery doesn’t improve cancer specific survival in patients with skeletal metastatic prostate cancer in the short term, but offers better local control, improves biochemical relapse-free survival, might prevent excessive interventions, reduce bone pain and metastasis.
James ND, Spears MR, Clarke NW, Dearnaley DP, De Bono JS, Gale J, et al. Survival with Newly Diagnosed Metastatic Prostate Cancer in the "Docetaxel Era": Data from 917 Patients in the Control Arm of the STAMPEDE Trial (MRC PR08, CRUK/06/019). European urology. 2015;67(6):1028-38.
Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Prostate Cancer Trialists' Collaborative Group. Lancet. 2000;355(9214):1491-8.
Tangen CM, Hussain MH, Higano CS, Eisenberger MA, Small EJ, Wilding G, et al. Improved overall survival trends of men with newly diagnosed M1 prostate cancer: a SWOG phase III trial experience (S8494, S8894 and S9346). The Journal of urology. 2012;188(4):1164-9.
Wu JN, Fish KM, Evans CP, Devere White RW, Dall'Era MA. No improvement noted in overall or cause-specific survival for men presenting with metastatic prostate cancer over a 20-year period. Cancer. 2014;120(6):818-23.
Ahmad AE, Leao R, Hamilton RJ. Radical Prostatectomy for Patients With Oligometastatic Prostate Cancer. Oncology. 2017;31(11):794-802.
Gautam G. Is it truly outrageous to consider radical prostatectomy for men with metastatic prostate cancer? Indian journal of urology : IJU : journal of the Urological Society of India. 2014;30(4):366-7.
Becker JA, Berg KD, Roder MA, Brasso K, Iversen P. Cytoreductive prostatectomy in metastatic prostate cancer: a systematic review. Scandinavian journal of urology. 2017:1-7.
Sooriakumaran P, Karnes J, Stief C, Copsey B, Montorsi F, Hammerer P, et al. A Multi-institutional Analysis of Perioperative Outcomes in 106 Men Who Underwent Radical Prostatectomy for Distant Metastatic Prostate Cancer at Presentation. European urology. 2016;69(5):788-94.
Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. The New England journal of medicine. 2001;345(23):1655-9.
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2002;20(5):1248-59.
Temple LK, Hsieh L, Wong WD, Saltz L, Schrag D. Use of surgery among elderly patients with stage IV colorectal cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2004;22(17):3475-84.
Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. The Lancet Oncology. 2004;5(4):219-28.
Heidenreich A, Pfister D, Porres D. Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. The Journal of urology. 2015;193(3):832-8.
Thompson IM, Tangen C, Basler J, Crawford ED. Impact of previous local treatment for prostate cancer on subsequent metastatic disease. The Journal of urology. 2002;168(3):1008-12.
Warde P, Mason M, Ding K, Kirkbride P, Brundage M, Cowan R, et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet. 2011;378(9809):2104-11.
Abdollah F, Suardi N, Gallina A, Bianchi M, Tutolo M, Passoni N, et al. Extended pelvic lymph node dissection in prostate cancer: a 20-year audit in a single center. Annals of oncology : official journal of the European Society for Medical Oncology. 2013;24(6):1459-66.
Joung JY, Cho IC, Lee KH. Role of pelvic lymph node dissection in prostate cancer treatment. Korean journal of urology. 2011;52(7):437-45.
Singh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, et al. Is there a favorable subset of patients with prostate cancer who develop oligometastases? International journal of radiation oncology, biology, physics. 2004;58(1):3-10.
Soloway MS, Hardeman SW, Hickey D, Raymond J, Todd B, Soloway S, et al. Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer. 1988;61(1):195-202.
Kim J, Park JS, Ham WS. The role of metastasis-directed therapy and local therapy of the primary tumor in the management of oligometastatic prostate cancer. Investigative and clinical urology. 2017;58(5):307-16.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205-13.
Basch E, Loblaw DA, Oliver TK, Carducci M, Chen RC, Frame JN, et al. Systemic therapy in men with metastatic castration-resistant prostate cancer:American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014;32(30):3436-48.
Liu JJ, Zhang J. Sequencing systemic therapies in metastatic castration-resistant prostate cancer. Cancer control : journal of the Moffitt Cancer Center. 2013;20(3):181-7.
Maluf FC, Smaletz O, Herchenhorn D. Castration-resistant prostate cancer: systemic therapy in 2012. Clinics. 2012;67(4):389-94.
Gandaglia G, Fossati N, Stabile A, Bandini M, Rigatti P, Montorsi F, et al. Radical Prostatectomy in Men with Oligometastatic Prostate Cancer: Results of a Single-institution Series with Long-term Follow-up. European urology. 2017;72(2):289-92.
Culp SH, Schellhammer PF, Williams MB. Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. European urology. 2014;65(6):1058-66.
Leyh-Bannurah SR, Gazdovich S, Budaus L, Zaffuto E, Briganti A, Abdollah F, et al. Local Therapy Improves Survival in Metastatic Prostate Cancer. European urology. 2017;72(1):118-24.
Novicki DE, Larson TR, Andrews PE, Swanson SK, Ferrigni RG. Comparison of the modified vest and the direct anastomosis for radical retropubic prostatectomy. Urology. 1997;49(5):732-6.
Sun M, Choueiri TK, Hamnvik OP, Preston MA, De Velasco G, Jiang W, et al. Comparison of Gonadotropin-Releasing Hormone Agonists and Orchiectomy: Effects of Androgen-Deprivation Therapy. JAMA oncology. 2016;2(4):500-7.
Kolinsky M, Rescigno P, de Bono JS. Chemical or Surgical Castration--Is This Still an Important Question? JAMA oncology. 2016;2(4):437-8.
- Abstract Viewed: 769 times
- PDF/4783 Downloaded: 230 times