Is radical prostatectomy safe for men with metastatic prostate cancer?

1. Despite the emergence of many new drugs, the OS of patients with metastatic prostate cancer has not been substantially prolonged in the past two decades. In recent years, surgical treatment of the primary lesion of patients with metastatic prostate cancer has received increasing attention. Some retrospective studies have shown that radical prostatectomy with cytoreduction can significantly prolong the OS and PFS of patients who have been strictly selected and performed by highly skilled surgeons.

2. Research background

Although important progress has been made in endocrine therapy, chemotherapy, and immunotherapy for metastatic prostate cancer, the 5-year overall survival rate of metastatic prostate cancer has not been significantly improved in the past 20 years. Statistics show that the 5-year overall survival rate of advanced metastatic prostate cancer is only about 30%.

Studies from renal cell carcinoma have shown that for patients with metastatic renal cancer, cytoreductive radical nephrectomy combined with interferon therapy can increase the one-year survival rate by 13% compared with interferon therapy alone. At the same time, studies from ovarian cancer have shown that ovarian cancer patients who undergo cytoreductive surgery to remove more than 75% of the tumor tissue can prolong the median survival time by 11 months compared with patients who undergo cytoreductive surgery to remove less than 25% of the tumor tissue. These studies suggest that cytoreductive surgery of the primary lesion may also benefit some patients with metastatic cancer.

In fact, in Europe and the United States, many patients with metastatic prostate cancer have undergone radical resection of the primary lesion. Therefore, it is necessary to evaluate the safety of radical prostatectomy for patients with metastatic prostate cancer. In this study, data from 106 patients with metastatic prostate cancer who underwent radical prostatectomy from 6 medical centers in the United States, Germany, Italy, and Sweden between 2007 and 2014 were retrospectively analyzed.

3. Research Results

The surgical method was radical prostatectomy with extended pelvic lymph node dissection, including 97 open surgeries and 9 robotic surgeries.

The median operation time was 2.5 hours, and 79.2% of the patients had no surgical complications.

In terms of surgical complications, the main surgical complications were: positive resection margin (53.8%), lymphatic fistula (8.5%), and incision infection (4.7%).

In terms of postoperative urinary control recovery, 3 months after surgery, 64.4% of patients recovered urinary control and did not need to use urine pads, and only 18.6% of patients needed to use more than 3 urine pads.

The median follow-up time after surgery was 22.8 months, and 88.7% of the patients were still alive.

4. Research conclusions and clinical significance review

This study found that for patients with metastatic prostate cancer whose primary lesions can be resected, radical prostatectomy with cytoreductive effect is safe and the surgical complication rate is no higher than that of patients with non-metastatic prostate cancer if appropriate cases are selected and performed by urologists with superb surgical skills.

This study is a retrospective study, and like some previous retrospective analyses, it further found that radical resection of the primary lesion benefits patients with metastatic prostate cancer. However, its conclusions have not yet been recommended by European and American diagnostic and treatment guidelines.

Currently, there are several prospective studies exploring the value of treating the primary lesion (radiotherapy or radical prostatectomy) in patients with metastatic prostate cancer. We are all waiting to see the conclusions of these studies!