SIU 2017: Cytoreductive and Palliative Radical Prostatectomy, Lymphadenectomy and Bilateral Orchiectomy in Advanced Prostate Cancer with Oligo-And Polymetastases

Lisbon Portugal (UroToday.com) The authors aimed to show the role of radical prostatectomy, lymphadenectomy and bilateral orchiectomy instead of androgen deprivation therapy (ADT) as an alternative treatment in patients with advanced prostate cancer with oligo-and bone poly-metastases.

Radical prostatectomy, extended lymphadenectomy and bilateral orchiectomy was done in 24 patients with advanced prostate cancer with bone metastases (group 1). Group 2 on the other hand, served as a control group and consisted of 23 patients with similar characteristics, who received ADT only without local therapy. The patients were followed with PSA, whole body bone scan, and other imaging and laboratory tests as required.

The mean age in patients group 1 was 61 and in group 2 was 67 years old. Mean follow up time was 12 months. Rising PSA occurred in 4 patients in group 1 and in 16 patients in group 2 (p=0.001). Bone metastasis decreased in 5 patients in group 1 and only in 2 patients in group 2 while it was increased in 3 patients in group 1 and in 5 patients in group 2. All patients in group 1 had no incontinence except one patient who required a cutaneous ureterostomy because of a contracted bladder. In group 2 trans-urethral resection of prostate (TURP) was done in 1 patient, permanent Foley catheter was needed in 4 patients, and bilateral percutaneous nephrostomy was performed in one patient. Recto-vesical fistula occurred in one patient during surgery (group 1). DVT occurred in two patients postoperatively. 

Biochemical failure was more prevalent in patients with poly metastases in comparison to oligo-metastases in both groups. Two patients died in each group due to metastatic prostate cancer.

The authors concluded that cytoreductive and palliative radical prostatectomy, extended lymphadenectomy and bilateral orchiectomy is feasible in metastatic advanced prostate cancer patients. Furthermore it might decrease biochemical relapse, when compared to ADT alone, at least in a short term follow-up.

This was a very small study, requiring a larger prospective cohort with a significantly longer follow-up, in order to validate these results. 


Presented by: Simforoosh, N.

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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