Michael J Metcalfe1, Marc C Smaldone2, Daniel W Lin3, Ana M Aparicio4, Brian F Chapin5. 1. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: michaelmetcalfe5@gmail.com. 2. Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA. 3. Department of Urology, University of Washington, Seattle, WA. 4. Department of Genitourinary Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. 5. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
CONTEXT: Recent demonstration of efficacy with the use of chemohormonal therapy for men with metastatic prostate cancer (mPCa) has expanded the therapeutic options for these patients. Furthermore, multimodal therapy to treat systemic disease in the context of locoregional control has gained increasing interest. Concomitantly, the role of radical prostatectomy (RP) in multimodal treatment for locally advanced prostate cancer is expanding. As a result, there is interest in investigating the potential benefit of cytoreductive RP in mPCa. OBJECTIVE: To review the literature regarding the role of cytoreductive prostatectomy in the setting of mPCa. EVIDENCE ACQUISITION: MEDLINE and PubMed electronic databases were queried for English language articles related to patients with mPCa who underwent RP from January 1990 to June 2016. Key words used in our search included cytoreductive prostatectomy, radical prostatectomy, and metastatic prostate cancer. Preclinical, retrospective, and prospective studies were included. EVIDENCE SYNTHESIS: There are no published randomized control trials examining the role of cytoreduction in mPCa. Local symptoms are high in mPCa and often provide a necessity for palliative procedures with the impact on oncologic outcomes being uncertain. Recently, preclinical and retrospective population-based data suggest a benefit from treatment of the primary tumor in metastatic disease. Potential mechanisms mediating this benefit include prevention of symptomatic local progression and modulation of disease biology, resulting in an improvement in progression-free and overall survival. Current literature supports the feasibility of cytoreductive prostatectomy as it is associated with acceptable side effects that are comparable to RP for high-risk localized disease. In aggregate, these data compel prospective evaluation of the hypothesis that cytoreductive prostatectomy improves the outcome of men with mPCa. CONCLUSIONS: Cytoreductive prostatectomy in mPCa is a feasible procedure that may improve outcomes for men when combined with multimodal management. Preclinical, translational, and retrospective evidence supports local therapy for metastatic disease. However, currently, evidence is limited and is subject to bias. The results of ongoing prospective randomized trials are required before incorporating this therapeutic strategy into clinical practice.
CONTEXT: Recent demonstration of efficacy with the use of chemohormonal therapy for men with metastatic prostate cancer (mPCa) has expanded the therapeutic options for these patients. Furthermore, multimodal therapy to treat systemic disease in the context of locoregional control has gained increasing interest. Concomitantly, the role of radical prostatectomy (RP) in multimodal treatment for locally advanced prostate cancer is expanding. As a result, there is interest in investigating the potential benefit of cytoreductive RP in mPCa. OBJECTIVE: To review the literature regarding the role of cytoreductive prostatectomy in the setting of mPCa. EVIDENCE ACQUISITION: MEDLINE and PubMed electronic databases were queried for English language articles related to patients with mPCa who underwent RP from January 1990 to June 2016. Key words used in our search included cytoreductive prostatectomy, radical prostatectomy, and metastatic prostate cancer. Preclinical, retrospective, and prospective studies were included. EVIDENCE SYNTHESIS: There are no published randomized control trials examining the role of cytoreduction in mPCa. Local symptoms are high in mPCa and often provide a necessity for palliative procedures with the impact on oncologic outcomes being uncertain. Recently, preclinical and retrospective population-based data suggest a benefit from treatment of the primary tumor in metastatic disease. Potential mechanisms mediating this benefit include prevention of symptomatic local progression and modulation of disease biology, resulting in an improvement in progression-free and overall survival. Current literature supports the feasibility of cytoreductive prostatectomy as it is associated with acceptable side effects that are comparable to RP for high-risk localized disease. In aggregate, these data compel prospective evaluation of the hypothesis that cytoreductive prostatectomy improves the outcome of men with mPCa. CONCLUSIONS: Cytoreductive prostatectomy in mPCa is a feasible procedure that may improve outcomes for men when combined with multimodal management. Preclinical, translational, and retrospective evidence supports local therapy for metastatic disease. However, currently, evidence is limited and is subject to bias. The results of ongoing prospective randomized trials are required before incorporating this therapeutic strategy into clinical practice.
Keywords:
Cytoreduction; Cytoreductive radical prostatectomy; Local treatment; Prostate cancer; Radical prostatectomy; Surgery in metastatic; Surgery in systemic; Treatment of primary tumor
Authors: André Deeke Sasse; Rodolfo Borges Dos Reis; Lucas Mendes Nogueira; Fernando Cotait Maluf; Daniel Herchenhorn; Oren Smaletz; Volney Soares Lima; Fábio Schutz; Diogo Bastos; Evanius Garcia Wiermann; Igor Alexandre Protzner Morbeck; Leonardo Fontes Jardim; Vinicius Carrera Souza; Icaro Thiago Carvalho; Elton Trigo Teixeira Leite; Archimedes Nardozza; Antonio Carlos Lima Pompeo; Francisco Bretas; Marcos Lima de Oliveira Leal; Marcus Vinicius Sadi; José Ricardo Tuma da Ponte; Gustavo F Carvalhal Journal: Int Braz J Urol Date: 2019 May-Jun Impact factor: 1.541