Gaya Josep M, Huguet Jorge, Breda Alberto, Palou Joan
Unidad de Uro-Oncología. Departamento de Urología. Fundació Puigvert. Universidad Autónoma de Barcelona. Barcelona. España.
Arch Esp Urol. 2018 Mar;71(3):288-297.
Metastatic prostate cancer is a very heterogeneous disease with several treatment options. In some cases of oligometastatic disease, local treatment of the primary tumor complemented by metastasis directed therapy seems to improve oncological results. The objectives of this study are to define and understand oligometastatic prostate cancer, to show the usefulness and rationale of cytoreductive surgery in this scenario and to review all published studies about radical prostatectomy in patients with initially metastatic prostate cancer.
We performed a Pubmed bibliographic search using the keywords: prostate cancer, metastatic, oligometastatic, local treatment, radical prostatectomy, and cytoreductive surgery. We included all published works on radical prostatectomy in initially metastatic patient. Furthermore, we reviewed published articles about cytoreductive surgery and biology of the oligometastatic disease in journals of different medical specialties.
Oligometastatic prostate cancer is recognized as an intermediate clinical stage between local and disseminated disease that seems to benefit from local treatment of the primary tumor plus metastasis directed treatment. In this scenario, different retrospective studies have demonstrated that radical prostatectomy diminishes local complication rate and improves oncological results without increasing morbidity. Currently, there is no consensus definition about the number, location, and imaging techniques to employ to consider a patient oligometastatic. Thus, it is difficult to compare the results of the different studies and identification of a subgroup of patients that could benefit from this local treatment.
In absence of prospective randomized data, radical prostatectomy seems to be useful for local treatment of the primary tumor in a selected group of patients with oligometastatic prostate cancer.
转移性前列腺癌是一种具有多种治疗选择的高度异质性疾病。在一些寡转移疾病病例中，对原发肿瘤进行局部治疗并辅以针对转移灶的治疗似乎能改善肿瘤学结局。本研究的目的是定义和理解寡转移前列腺癌，展示在这种情况下减瘤手术的实用性和理论依据，并回顾所有已发表的关于初始转移性前列腺癌患者根治性前列腺切除术的研究。
我们使用关键词“前列腺癌、转移性、寡转移性、局部治疗、根治性前列腺切除术、减瘤手术”在PubMed上进行文献检索。我们纳入了所有已发表的关于初始转移性患者根治性前列腺切除术的研究。此外，我们还回顾了不同医学专业期刊上发表的关于减瘤手术和寡转移疾病生物学的文章。
寡转移前列腺癌被认为是局部疾病和播散性疾病之间的一个中间临床阶段，似乎从原发肿瘤的局部治疗加针对转移灶的治疗中获益。在这种情况下，不同的回顾性研究表明，根治性前列腺切除术可降低局部并发症发生率并改善肿瘤学结局，且不增加发病率。目前，对于将患者视为寡转移所需考虑的转移灶数量、位置和成像技术尚无共识定义。因此，很难比较不同研究的结果，也难以确定可能从这种局部治疗中获益的患者亚组。
在缺乏前瞻性随机数据的情况下，根治性前列腺切除术似乎对选定的寡转移前列腺癌患者的原发肿瘤局部治疗有用。
