San Diego, CA USA (UroToday.com) Dr. Brian Chapin from MD Anderson discussed on the role of cytoreductive prostatectomy in patients with M1 disease. Recent population based studies (SEER and Munich Cancer Registry) suggest an improvement in survival in patients who are treated with definitive local therapy (RT or RRP). Additionally, symptomatic progression is reduced with treatment of the primary treatment.
In one study, M1 patients who had RRP or EBRT had 20% and 47% respective late local complications at CRPC, while patients who had no local treatment had up to 54% late local complications. Late intervention has significant risks. Patients who undergo palliative cystoprostatectomy have significant risk of rectal injury and subsequent surgery.
Despite systemic therapy, molecularly “lethal prostate cancer” persists in primary treatment tumor. Therefore, a localized therapy is needed and may further alter tumor biology. Primary tumor can be a driving force for metastatic disease and removal of primary tumor can disrupt progression of disease.
Dr. Chapin hypothesizes that controlling the primary tumor will improve outcomes and survival of men with metastatic prostate cancer. The group is currently doing a multi-center randomized Phase II Trial of Best Systemic Therapy (BST) or BST plus definitive treatment of the primary tumor in metastatic prostate cancer. While end-points are yet to obtain, the study suggests that the cytoreductive prostatectomy is safe and is well selected in patients with metastasis. The complication rates for Clavien III is 7% and continence rate is 90%.
Dr. Chapin summarizes that the radical prostatectomy in men with M1 prostate cancer is feasible and safe and may improve outcomes. A further Phase III trial is in plans currently to assess survival outcomes.
Presented By: Brian Chapin , MD
Written By: Mohammed Haseebuddin, MD; Fox Chase Cancer Center, Philadelphia, PA at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA
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