Surgical treatment of local disease in metastatic prostate cancer.
Authors: Josep M. Gaya, Jorge Huguet, Alberto Breda y Joan Palou.
Arch. Esp. Urol. 2018; 71 (3): 288-297
Vol. 71, Number. 3, April 2018
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 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.
ONLY IN SPANISH