Pelvic exenteration surgery in patients with locally advanced castration-naïve and castration-resistant, symptomatic prostate cancer.

To retrospectively evaluate the surgical, symptomatic and oncological outcome following pelvic extenteration surgery (PES) in men with significant intrapelvic complications of locally advanced castration-sensitive (CSPC) and castration resistant prostate cancer (CRPC).

103 patients with locally advanced progressive and symptomatic CS/CRPC underwent PES: radical cystoprostatectomy in n=71 (68.9%), radical prostatectomy with continent vesicostomy in n=9 (8.7%), total exenteration in n=23 (22.3%). All patients underwent local staging via MRI, cystoscopy and rectoscopy. Systemic staging was done with chest, abdominal, pelvic CT scans and bone scans. Perioperative complications were assessed according to Clavien-Dindo classification. Symptom-free (SFS), overall survival (OS) were evaluated using the Kaplan-Meier method. Statistical tests were two-tailed with a p-value <0.05 considered to indicate significance.

After a median follow-up of 36.5 (3 - 123) months, the SFS at 1 and 3 years was 89.2% (n=89) and 64.1% (n=66). The median SFS was 27.9 months. 78.6% of the patients were symptom-free during their remaining lifetime. OS at 1 and 3 years was 92.2% and 43.7%, respectively, and the median OS was 33.6 months. Clavien-Dindo grade 2, 3 and 4 complications developed in 31 (30.6%), 12 (11.6%) and 8 (8.1%), respectively.

PES is technically feasible in well-selected patients resulting in symptom relief in > 90% of patients covering 80% of the remaining life time.

BJU international. 2020 Apr 22 [Epub ahead of print]

Axel Heidenreich, Mark Bludau, Christiane Bruns, Tim Nestler, Daniel Porres, David Johannes Karl Paul Pfister

Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Germany., Department of Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany.