To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.
We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results.
In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%.
CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.
Asian journal of urology. 2022 Nov 29 [Epub]
Andrey Morozov, Leonid Chuvalov, Mark Taratkin, Mikhail Enikeev, Leonid Rapoport, Nirmish Singla, Eric Barret, Elena Poddubskaya, Maria Borodina, Georg Salomon, Juan Gomez Rivas, Dmitry Enikeev
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, USA., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Sechenov University, Moscow, Russia., Hertsen Moscow Oncology Research Institute, Moscow, Russia., Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain.