Surgical treatment of local disease in metastatic prostate cancer

Josep M. Gaya, Jorge Huguet, Alberto Breda, Joan Palou

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    Abstract

    © 2018 Iniestares, S.A. All rights reserved. Objectives: Metastatic prostate cancer is a very heterogeneous disease with several treatment options. In some cases of oligometastatic disease, local treatment of the primary tumor complemented by 288 MONOGRÁFICO: CÁNCER DE PRÓSTATA AVANZADO. PARTE I. FUNDAMENTOS ARTÍCULO ORIGINAL Arch. Esp. Urol. 2018; 71 (3): 288-297 metastasis directed therapy seems to improve oncological results. The objectives of this study are to define and understand oligometastatic prostate cancer, to show the usefulness and rationale of cytoreductive surgery in this scenario and to review all published studies about radical prostatectomy in patients with initially metastatic prostate cancer. Methods: We performed a Pubmed bibliographic search using the keywords: prostate cancer, metastatic, oligometastatic, local treatment, radical prostatectomy, and cytoreductive surgery. We included all published works on radical prostatectomy in initially metastatic patient. Furthermore, we reviewed published articles about cytoreductive surgery and biology of the oligometastatic disease in journals of different medical specialties. Results: Oligometastatic prostate cancer is recognized as an intermediate clinical stage between local and disseminated disease that seems to benefit from local treatment of the primary tumor plus metastasis directed treatment. In this scenario, different retrospective studies have demonstrated that radical prostatectomy diminishes local complication rate and improves oncological results without increasing morbidity. Currently, there is no consensus definition about the number, location, and imaging techniques to employ to consider a patient oligometastatic. Thus, it is difficult to compare the results of the different studies and identification of a subgroup of patients that could benefit from this local treatment. Conclusions: In absence of prospective randomized data, radical prostatectomy seems to be useful for local treatment of the primary tumor in a selected group of patients with oligometastatic prostate cancer.
    Original languageEnglish
    Pages (from-to)288-297
    JournalArchivos Espanoles de Urologia
    Volume71
    Issue number3
    Publication statusPublished - 1 Apr 2018

    Keywords

    • Cytoreductive surgery
    • Local treatment
    • Metastatic
    • Oligometastatic
    • Prostate cancer
    • Radical prostatectomy

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