Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur Urol Focus. 2017 Dec;3(6):646-649. doi: 10.1016/j.euf.2017.06.016. Epub 2017 Jul 8.
The impact of cytoreductive radical prostatectomy (CRP) on oncological outcomes in patients with prostate cancer (PCa) and distant metastases has been demonstrated by retrospective data with their potential selection bias. Using prospective institutional data, we compared the outcomes between 43 PCa patients with low-volume bone metastases (1-3 lesions) undergoing CRP (median follow-up 32.7 mo) and 40 patients receiving best systemic therapy (BST; median follow-up 82.2 mo). The inclusion criteria for both cohorts were identical. So far, no significant difference in castration resistant-free survival (p=0.92) or overall survival (p=0.25) has been detected. Compared to recent reports, the outcomes for our control group are more favorable, indicating a potential selection bias in the previous retrospective studies. Therefore, the unclear oncological effect has to be weighed against the potential risks of CRP. However, patients benefit from a significant reduction in locoregional complications (7.0% vs 35%; p<0.01) when undergoing CRP.
In this study we analyzed the impact of surgery in patients with prostate cancer and bone metastases. Using prospective data, we could not show a significant benefit of surgery on survival, but the rate of locoregional complications was lower. Therefore, patients should be treated within prospective trials evaluating the role of cytoreductive prostatectomy in low-volume, bone metastatic prostate cancer.
通过回顾性数据已经证明了前列腺癌（PCa）伴远处转移患者行根治性前列腺切除术（CRP）对肿瘤学结果的影响，但这些数据可能存在潜在的选择偏倚。本研究利用前瞻性机构数据，比较了 43 例接受 CRP（中位随访 32.7 个月）的低容量骨转移（1-3 个病灶）PCa 患者和 40 例接受最佳全身治疗（BST；中位随访 82.2 个月）的患者之间的结果。两个队列的纳入标准完全相同。到目前为止，无复发生存（p=0.92）或总生存（p=0.25）方面无显著差异。与最近的报告相比，我们的对照组结果更有利，表明以前的回顾性研究存在潜在的选择偏倚。因此，CRP 的潜在风险必须与不清楚的肿瘤学效果相权衡。然而，当患者接受 CRP 时，他们会显著降低局部区域并发症的风险（7.0%比 35%；p<0.01）。
在这项研究中，我们分析了手术对前列腺癌和骨转移患者的影响。使用前瞻性数据，我们未能显示手术对生存有显著益处，但局部区域并发症的发生率较低。因此，患者应在评估 CRP 在低容量骨转移前列腺癌中的作用的前瞻性试验中接受治疗。
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