Mandel Philipp, Steuber Thomas, Graefen Markus
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Curr Opin Urol. 2017 Nov;27(6):572-579. doi: 10.1097/MOU.0000000000000445.
Although cytoreductive surgery is accompanied with prolonged survival in many other malignancies in a metastatic stage, its role in oligometastatic prostate cancer is unclear.
Radical prostatectomy (RP) in patients with oligometastatic prostate cancer seems to be feasible. Perioperative complication rates vary between 20 and 50% (Clavien 1-3) and are comparable to patients with locally advanced tumors. Postoperative functional outcomes (urinary continence and erectile function) can be slightly worse than in patients with locally advanced tumor. In literature, an oncological benefit of surgery is so far only described for retrospective multiinstitutional databases and a case-control study but not for prospective studies. Still, men undergoing RP clearly seem to develop severe local complications less frequently than patients receiving best systemic therapy (up to more than 50% versus less than10%).
Patients should be counseled about the potential significant reduction of local complications whenever undergoing RP for oligometastatic prostate cancer. Nevertheless, as complication rates are relatively high, functional outcome can be slightly worse compared with RP with curative intent and especially as oncological benefit so far is shown using retrospective but not prospective data, patients should only undergo surgery within the ongoing prospective, randomized trials.
尽管减瘤手术在许多其他处于转移阶段的恶性肿瘤中可延长生存期，但其在寡转移前列腺癌中的作用尚不清楚。
对寡转移前列腺癌患者进行根治性前列腺切除术（RP）似乎是可行的。围手术期并发症发生率在20%至50%之间（Clavien 1-3级），与局部晚期肿瘤患者相当。术后功能结局（尿失禁和勃起功能）可能比局部晚期肿瘤患者略差。在文献中，手术的肿瘤学益处目前仅在回顾性多机构数据库和一项病例对照研究中有所描述，而前瞻性研究中未见报道。尽管如此，接受RP的男性明显比接受最佳全身治疗的患者发生严重局部并发症的频率更低（高达50%以上对不到10%）。
对于接受寡转移前列腺癌RP治疗的患者，应告知其局部并发症可能显著减少。然而，由于并发症发生率相对较高，与根治性RP相比，功能结局可能略差，尤其是目前肿瘤学益处是通过回顾性而非前瞻性数据显示的，因此患者应仅在正在进行的前瞻性随机试验中接受手术。
