SIU 2017: Role of Cytoreductive Surgery in CRPC

Lisbon, Portugal (UroToday.com) There has been a paradigm shift in several solid tumors, emphasizing locoregional treatment in the presence of metastatic disease. The question Dr. Hammerer raises in this presentation is whether local therapy should be performed in CRPC men or/and men with oligometastatic disease with a rising PSA on androgen deprivation therapy (ADT).

It has been shown that metastatic CRPC are a heterogeneous group with visceral metastasis conferring a worse prognosis than bone or lymph node metastasis. Standard of care for patients with de novo metastatic prostate cancer (PC) is androgen deprivation therapy +/- Docetaxel or Abiraterone. Local ablative treatment may prevent local symptoms including pain, obstructive urinary symptoms, and hematuria. To date, in men with metastatic PC or CRPC, no randomized prospective data support local ablative treatment of the primary. However, it is known that potentially lethal cancers persist in the primary tumor and may contribute to the progression of systemic disease. Studies have shown that primary treatment of the prostate improves local palliation in men who ultimately develop CRPC, and that it is a feasible procedure. It has also been shown to improve survival in metastatic PC. Due to the fact the role of cytoreductive prostatectomy is still unknown, prospective trials evaluating its role are needed.

In conclusion, retrospective studies based on registries suggest survival benefit for local treatment. Available data are not prospective, subject to selection bias, require validation in prospective RCTs with overall survival as the primary endpoint. Until such data is available, more retrospective multi-institutional data should continue to be collected.

Presented by: Peter Hammerer, Germany

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal
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