Cytoreductive Radical Prostatectomy in Patients with Prostate Cancer and Low Volume Skeletal Metastases: Results of a Feasibility and Case-Control Study

No AccessJournal of UrologyAdult Urology1 Mar 2015Cytoreductive Radical Prostatectomy in Patients with Prostate Cancer and Low Volume Skeletal Metastases: Results of a Feasibility and Case-Control Study Axel Heidenreich, David Pfister, and Daniel Porres Axel HeidenreichAxel Heidenreich More articles by this author , David PfisterDavid Pfister More articles by this author , and Daniel PorresDaniel Porres More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.09.089AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Androgen deprivation represents the standard treatment for prostate cancer with osseous metastases. We explored the role of cytoreductive radical prostatectomy in prostate cancer with low volume skeletal metastases in terms of a feasibility study. Materials and Methods: A total of 23 patients with biopsy proven prostate cancer, minimal osseous metastases (3 or fewer hot spots on bone scan), absence of visceral or extensive lymph node metastases and prostate specific antigen decrease to less than 1.0 ng/ml after neoadjuvant androgen deprivation therapy were included in the feasibility study (group 1). A total of 38 men with metastatic prostate cancer who were treated with androgen deprivation therapy without local therapy served as the control group (group 2). Surgery related complications, time to castration resistance, and symptom-free, cancer specific and overall survival were analyzed using descriptive statistical analysis. Results: Mean patient age was 61 (range 42 to 69) and 64 (range 47 to 83) years in groups 1 and 2, respectively, with similar patient characteristics in terms of initial prostate specific antigen, biopsy Gleason score, clinical stage and extent of metastatic disease. Median followup was 34.5 months (range 7 to 75) and 47 months (range 28 to 96) in groups 1 and 2, respectively. Median time to castration resistant prostate cancer was 40 months (range 9 to 65) and 29 months (range 16 to 59) in groups 1 and 2, respectively (p=0.04). Patients in group 1 experienced significantly better clinical progression-free survival (38.6 vs 26.5 months, p=0.032) and cancer specific survival rates (95.6% vs 84.2%, p=0.043), whereas overall survival was similar. Of the men in groups 1 and 2, 20% and 29%, respectively, underwent palliative surgical procedures for locally progressing prostate cancer. Conclusions: Cytoreductive radical prostatectomy is feasible in well selected men with metastatic prostate cancer who respond well to neoadjuvant androgen deprivation therapy. These men have a long life expectancy, and cytoreductive radical prostatectomy reduces the risk of locally recurrent prostate cancer and local complications. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByBuck M, Ghiraldi E, Demkowicz P, Park H, An Y, Kann B, Yu J, Sprenkle P, Kim I and Leapman M (2021) Facility-Level Variation in Use of Locoregional Therapy for Metastatic Prostate CancerUrology Practice, VOL. 9, NO. 2, (140-149), Online publication date: 1-Mar-2022.Taneja S (2018) Re: Meta-Analysis Evaluating the Impact of Site of Metastasis on Overall Survival in Men with Castration-Resistant Prostate CancerJournal of Urology, VOL. 196, NO. 3, (742-742), Online publication date: 1-Sep-2016.Steers W (2018) This Month in Adult UrologyJournal of Urology, VOL. 193, NO. 3, (747-748), Online publication date: 1-Mar-2015.Crispen P (2018) Should We Perform Prostatectomy in the Face of Metastatic Prostate Cancer?Journal of Urology, VOL. 193, NO. 3, (754-755), Online publication date: 1-Mar-2015.Satkunasivam R, Kim A, Desai M, Nguyen M, Quinn D, Ballas L, Lewinger J, Stern M, Hamilton A, Aron M and Gill I (2018) Radical Prostatectomy or External Beam Radiation Therapy vs No Local Therapy for Survival Benefit in Metastatic Prostate Cancer: A SEER-Medicare AnalysisJournal of Urology, VOL. 194, NO. 2, (378-385), Online publication date: 1-Aug-2015. Volume 193Issue 3March 2015Page: 832-838 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsneoplasm metastasisandrogensbone and bonesneoadjuvant therapyMetricsAuthor Information Axel Heidenreich More articles by this author David Pfister More articles by this author Daniel Porres More articles by this author Expand All Advertisement PDF DownloadLoading ...