Paper Information

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

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

 
 
Author(s):  SIMFOROOSH NASSER*, Dadpour Mehdi, MOFID BAHRAM
 
* Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, 9th Boostan, Pasdaran avenue, Tehran, Iran
 
Abstract: 
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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