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AUA 2019

AUA 2019: Multivisceral Surgery in Men with Locally Advanced, Symptomatic Castration-Resistant Prostate Cancer

Chicago, IL (Urotoday.com) Men with locally advanced castrate-resistant prostate adenocarcinoma (CRPC) can often have very bothersome symptoms such as recurrent gross hematuria, need for blood transfusions, upper and lower urinary tract obstruction, intestinal obstruction, and pelvic pain that can significantly affect quality of life. More recently systemic therapies have been introduced to help treat CRPC, such as newer-generation anti-androgens, however, they may not alleviate many of the aforementioned symptoms.

Dr. Friederike Haidl from the University Hospital Cologne, in Cologne, Germany discussed her group’s study evaluating the efficacy of performing palliative pelvic surgery in men with symptomatic locally-advanced CRPC. They retrospectively identified 103 men who had undergone palliative surgery at their institution.

They noted that palliative pelvic surgery for locally-advanced CRPC is not a standard treatment and should only be performed at a center of excellence. All patients have a comprehensive pre-operative evaluation including a local staging MRI of the pelvis, cystoscopy / rectoscopy, and systemic staging prior to being considered for surgery.

They found that of their series 61.5% of patients underwent a radical cystoprostatectomy with ileal conduit diversion, 8.7% underwent radical prostatectomy with continent vesicostomy, and 16.5% underwent a total pelvic exenteration with both urinary and bowel diversions. The indications for these surgeries were upper or lower urinary tract obstruction in 54.3% and 39.8%, respectively, hematuria requiring transfusions in 22.3%, rectal infiltration in 16.5%, refractory pelvic pain in 12.6%, or a combination of these symptoms in 65.1%.

They evaluated their outcomes and found that at a median follow-up of 36.5 months the symptom-free survival (SFS) at 1 and 3 years was 90.3% and 66.9%, respectively. Median SFS was 27.9 months. Cancer specific-survival at 1 and 3 years was 92.2% and 43.7%, respectively.

They concluded that Multivisceral radical pelvic surgery for palliation of symptomatic locally-advanced CRPC is a technically feasible approach in carefully selected patients. They believe that surgical intervention should be considered more frequently in symptomatic patients, but caution that an extensive pre-operative evaluation to evaluate feasibility and safety of surgery is required.

Presented by: Friederike Haidl, MD, Department of Urology, University Hospital Cologne, Cologne, Germany

Written by: Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, Pennsylvania, @btkmduro at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois