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Paper Information

Journal:   UROLOGY JOURNAL   March-April 2019 , Volume 16 , Number 2; Page(s) 162 To 167.

Cytoreductive and Palliative Radical Prostatectomy, Extended Lymphadenectomy and Bilateral Orchiectomy in Advanced Prostate Cancer with Oligo and Widespread Bone Metastases: Result of Feasibility, Our Initial Experience

* Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, 9th Boostan, Pasdaran avenue, Tehran, Iran
To evaluate the feasibility of cytoreductive radical prostatectomy (CRP), lymphadenectomy, and bilateral orchiectomy in patients with advanced prostate cancer with oligo-and poly-metastases. Furthermore, the functional and oncological outcomes of these patients in comparison with the control group that underwent treatment only with systemic therapy (ST group) is investigated in a well-selected, prospective cohort study. Material and methods: A total of 26 patients were enrolled in CRP group and 23 patients in ST group. The patients have been followed (9 to 43 months(median: 19. 5)) with PSA (prostate specific antigen), whole body bone scan and other necessary imaging and laboratory tests. Functional and oncological outcomes were compared between two groups. Results: Biochemical relapse occurred in 9 patients (34. 6%) in CRP group and in 17 patients (73. 9%) in ST group (P = 0. 01). Whole-body bone scans showed more reduced metastasis volume in CRP group (P = 0. 003). There was no voiding dysfunction in 22 patients in CRP group post-operatively (84. 6%), while in ST group trans-urethral resection of prostate or permanent Foley catheter was needed in 8 patients (34. 7%) and bilateral percutaneous nephrostomy was done in one patient. Six patients in CRP group (23%) and eight patients in ST group (34. 7%) died because of prostate cancer and there was no difference between cancer specific survival between the two groups (P = 0. 975). Conclusion: Although surgery doesn’ t improve cancer specific survival in patients with skeletal metastatic prostate cancer in the short term, but offers better local control, improves biochemical relapse-free survival, might prevent excessive interventions,and reduce bone pain and metastasis.
Keyword(s): prostate neoplasms,metastasis,oligo and wide-spread metastasis,cyto-reductive radical prostatectomy,bilateral orchiectomy,functional and oncologic outcome
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