Heidenreich Axel, Pfister David, Porres Daniel
Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany.
Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany.
J Urol. 2015 Mar;193(3):832-8. doi: 10.1016/j.juro.2014.09.089. Epub 2014 Sep 22.
Androgen deprivation represents the standard treatment for prostate cancer with osseous metastases. We explored the role of cytoreductive radical prostatectomy in prostate cancer with low volume skeletal metastases in terms of a feasibility study.
A total of 23 patients with biopsy proven prostate cancer, minimal osseous metastases (3 or fewer hot spots on bone scan), absence of visceral or extensive lymph node metastases and prostate specific antigen decrease to less than 1.0 ng/ml after neoadjuvant androgen deprivation therapy were included in the feasibility study (group 1). A total of 38 men with metastatic prostate cancer who were treated with androgen deprivation therapy without local therapy served as the control group (group 2). Surgery related complications, time to castration resistance, and symptom-free, cancer specific and overall survival were analyzed using descriptive statistical analysis.
Mean patient age was 61 (range 42 to 69) and 64 (range 47 to 83) years in groups 1 and 2, respectively, with similar patient characteristics in terms of initial prostate specific antigen, biopsy Gleason score, clinical stage and extent of metastatic disease. Median followup was 34.5 months (range 7 to 75) and 47 months (range 28 to 96) in groups 1 and 2, respectively. Median time to castration resistant prostate cancer was 40 months (range 9 to 65) and 29 months (range 16 to 59) in groups 1 and 2, respectively (p=0.04). Patients in group 1 experienced significantly better clinical progression-free survival (38.6 vs 26.5 months, p=0.032) and cancer specific survival rates (95.6% vs 84.2%, p=0.043), whereas overall survival was similar. Of the men in groups 1 and 2, 20% and 29%, respectively, underwent palliative surgical procedures for locally progressing prostate cancer.
Cytoreductive radical prostatectomy is feasible in well selected men with metastatic prostate cancer who respond well to neoadjuvant androgen deprivation therapy. These men have a long life expectancy, and cytoreductive radical prostatectomy reduces the risk of locally recurrent prostate cancer and local complications. Cytoreductive radical prostatectomy might be a treatment option in the multimodality management of prostate cancer with minimal osseous metastases.
雄激素剥夺是前列腺癌骨转移的标准治疗方法。我们通过一项可行性研究，探讨了减瘤性根治性前列腺切除术在低负荷骨转移前列腺癌中的作用。
共有23例经活检证实为前列腺癌、骨转移极少（骨扫描显示3个或更少热点）、无内脏或广泛淋巴结转移且新辅助雄激素剥夺治疗后前列腺特异性抗原降至低于1.0 ng/ml的患者纳入可行性研究（第1组）。共有38例接受雄激素剥夺治疗而未接受局部治疗的转移性前列腺癌男性作为对照组（第2组）。使用描述性统计分析来分析手术相关并发症、去势抵抗时间以及无症状生存期、癌症特异性生存期和总生存期。
第1组和第2组患者的平均年龄分别为61岁（范围42至69岁）和64岁（范围47至83岁），在初始前列腺特异性抗原、活检Gleason评分、临床分期和转移疾病范围方面具有相似的患者特征。第1组和第2组的中位随访时间分别为34.5个月（范围7至75个月）和47个月（范围28至96个月）。第1组和第2组去势抵抗性前列腺癌的中位时间分别为40个月（范围9至65个月）和29个月（范围16至59个月）（p = 0.04）。第1组患者的临床无进展生存期（38.6个月对26.5个月，p = 0.032）和癌症特异性生存率（95.6%对84.2%，p = 分）显著更好，而总生存期相似。第1组和第2组中分别有20%和29%的男性因局部进展性前列腺癌接受了姑息性手术。
对于精心挑选的、对新辅助雄激素剥夺治疗反应良好的转移性前列腺癌男性患者，减瘤性根治性前列腺切除术是可行的。这些男性预期寿命较长，减瘤性根治性前列腺切除术可降低局部复发性前列腺癌和局部并发症的风险。减瘤性根治性前列腺切除术可能是低负荷骨转移前列腺癌多模式治疗中的一种选择。
