Abstract
Background:
Surgical treatment of the primary tumor in patients with metastatic prostate cancer (mPCa) is gaining traction. We discuss the biological rational and the existing literature on this approach.
Methods:
We reviewed the literature regarding surgical management of advanced and mPCa disease.
Results:
Surgical removal of the primary tumor despite metastases is becoming a standard in an increasing number of malignancies. Basic science data support the use of surgical removal of the prostate in metastatic PCa. In addition, durable long-term survival has been reported in patients with node-positive PCa treated with radical prostatectomy (RP) as mono or multimodal approach. Based on these data, several groups have demonstrated the feasibility and safety of RP in the metastatic setting. Retrospective series have also reported an improvement in survival for metastatic patients treated with RP in addition to systemic treatment.
Conclusions:
Although no level I data exist at this time to support the use of RP in clinically node-positive or mPCa patients, retrospective data together with basic research data and experience from other malignancies suggest that treatment of the primary tumor, in form of a RP, is safe and could improve long-term quality of life and survival. However, prospective evaluations are requested to validate these findings before including in the standard clinical practice.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Siegel RL, Miller KD, Jemal A . Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5–29.
Welch HG, Gorski DH, Albertsen PC . Trends in metastatic breast and prostate cancer—lessons in cancer dynamics. N Engl J Med 2015; 373: 1685–1687.
Cooperberg MR, Lubeck DP, Meng M V, Mehta SS, Carroll PR . The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. J Clin Oncol 2004; 22: 2141–2149.
Fossati N, Passoni NM, Moschini M, Gandaglia G, Larcher A, Freschi M et al. Impact of stage migration and practice changes on high-risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades. BJU Int 2015; 117: 740–747.
De Angelis G, Rittenhouse HG, Mikolajczyk SD, Blair Shamel L, Semjonow A . Twenty years of PSA: from prostate antigen to tumor marker. Rev Urol 2007; 9: 113–123.
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T et al. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2014; 65: 467–479.
Prostate cancer: NCCN guidelines for prostate cancer updated. Nat Rev Urol 2015; 12: 63.
Sweeney CJ, Chen Y-H, Carducci M, Liu G, Jarrard DF, Eisenberger M et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 2015; 373: 737–746.
Ruiterkamp J, Ernst MF . The role of surgery in metastatic breast cancer. Eur J Cancer 2011; 47: S6–22.
Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R, . European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet (London, England) 2001; 358: 966–970.
Temple LKF, Hsieh L, Wong WD, Saltz L, Schrag D . Use of surgery among elderly patients with stage IV colorectal cancer. J Clin Oncol 2004; 22: 3475–3484.
Schröder FH, Kurth K-H, Fossa SD, Hoekstra W, Karthaus PP, De Prijck L et al. Early versus delayed endocrine treatment of T2-T3 pN1-3 M0 prostate cancer without local treatment of the primary tumour: final results of European Organisation for the Research and Treatment of Cancer protocol 30846 after 13 years of follow-up (a randomised controlled trial). Eur Urol 2009; 55: 14–22.
Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2014; 33: 272–277.
Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol 2015; 33: 3379–3385.
Moschini M, Fossati N, Abdollah F, Gandaglia G, Cucchiara V, Dell’Oglio P et al. Determinants of long-term survival of patients with locally advanced prostate cancer: the role of extensive pelvic lymph node dissection. Prostate Cancer Prostatic Dis 2015; 19: 63–67.
Gakis G, Boorjian SA, Briganti A, Joniau S, Karazanashvili G, Karnes RJ et al. The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature. Eur Urol 2013; 66: 191–199.
Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001; 345: 1655–1659.
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ . Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002; 20: 1248–1259.
Kadmon D, Heston WD, Fair WR . Treatment of a metastatic prostate derived tumor with surgery and chemotherapy. J Urol 1982; 127: 1238–1242.
Kim M-Y, Oskarsson T, Acharyya S, Nguyen DX, Zhang XH-F, Norton L et al. Tumor self-seeding by circulating cancer cells. Cell 2009; 139: 1315–1326.
Psaila B, Lyden D . The metastatic niche: adapting the foreign soil. Nat Rev Cancer 2009; 9: 285–293.
Haffner MC, Mosbruger T, Esopi DM, Fedor H, Heaphy CM, Walker DA et al. Tracking the clonal origin of lethal prostate cancer. J Clin Invest 2013; 123: 4918–4922.
Lussier YA, Khodarev NN, Regan K, Corbin K, Li H, Ganai S et al. Oligo- and polymetastatic progression in lung metastasis(es) patients is associated with specific microRNAs. PLoS One 2012; 7: e50141.
Hong MKH, Macintyre G, Wedge DC, Van Loo P, Patel K, Lunke S et al. Tracking the origins and drivers of subclonal metastatic expansion in prostate cancer. Nat Commun 2015; 6: 6605.
Gundem G, Van Loo P, Kremeyer B, Alexandrov LB, Tubio JMC, Papaemmanuil E et al. The evolutionary history of lethal metastatic prostate cancer. Nature 2015; 520: 353–357.
Ost P, Jereczek-Fossa BA, As N, Van, Zilli T, Muacevic A, Olivier K et al. Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multi-institutional analysis. Eur Urol 2016; 69: 9–12.
Engel J, Bastian PJ, Baur H, Beer V, Chaussy C, Gschwend JE et al. Survival benefit of radical prostatectomy in lymph node-positive patients with prostate cancer. Eur Urol 2010; 57: 754–761.
Steuber T, Budäus L, Walz J, Zorn KC, Schlomm T, Chun F et al. Radical prostatectomy improves progression-free and cancer-specific survival in men with lymph node positive prostate cancer in the prostate-specific antigen era: a confirmatory study. BJU Int 2011; 107: 1755–1761.
Ghavamian R, Bergstralh EJ, Blute ML, Slezak J, Zincke H . Radical retropubic prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancer: a matched comparison. J Urol 1999; 161: 1223–1228.
van den Ouden D, Davidson PJ, Hop W, Schröder FH . Radical prostatectomy as a monotherapy for locally advanced (stage T3) prostate cancer. J Urol 1994; 151: 646–651.
Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 2006; 7: 472–479.
Touijer KA, Mazzola CR, Sjoberg DD, Scardino PT, Eastham JA . Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy. Eur Urol 2014; 65: 20–25.
Da Pozzo LF, Cozzarini C, Briganti A, Suardi N, Salonia A, Bertini R et al. Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy. Eur Urol 2009; 55: 1003–1011.
Moschini M, Sharma V, Zattoni F, Quevedo JF, Davis BJ, Kwon E et al. Natural history of clinical recurrence patterns of lymph node-positive prostate cancer after radical prostatectomy. Eur Urol 2015; 69: 135–142.
Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N et al. Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 2009; 55: 261–270.
Nini A, Gandaglia G, Fossati N, Suardi N, Cucchiara V, Dell’Oglio P et al. Patterns of clinical recurrence of node-positive prostate cancer and impact on long-term survival. Eur Urol 2015; 68: 777–784.
Boorjian SA, Thompson RH, Siddiqui S, Bagniewski S, Bergstralh EJ, Karnes RJ et al. Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol 2007; 178: 864–870, discussion 870–871.
Abdollah F, Karnes RJ, Suardi N, Cozzarini C, Gandaglia G, Fossati N et al. Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer. J Clin Oncol 2014; 32: 3939–3947.
Passoni NM, Fajkovic H, Xylinas E, Kluth L, Seitz C, Robinson BD et al. Prognosis of patients with pelvic lymph node (LN) metastasis after radical prostatectomy: value of extranodal extension and size of the largest LN metastasis. BJU Int 2014; 114: 503–510.
Carlsson S V, Tafe LJ, Chade DC, Sjoberg DD, Passoni N, Shariat SF et al. Pathological features of lymph node metastasis for predicting biochemical recurrence after radical prostatectomy for prostate cancer. J Urol 2013; 189: 1314–1318.
Abdollah F, Gandaglia G, Suardi N, Capitanio U, Salonia A, Nini A et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 2014, 1–8.
Briganti A, Karnes RJ, Da Pozzo LF, Cozzarini C, Capitanio U, Gallina A et al. Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis. Eur Urol 2011; 59: 832–840.
Briganti A, Abdollah F, Nini A, Suardi N, Gallina A, Capitanio U et al. Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol 2012; 61: 1132–1138.
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 2012; 61: 480–487.
Moschini M, Briganti A, Murphy CR, Bianchi M, Gandaglia G, Montorsi F et al. Outcomes for patients with clinical lymphadenopathy treated with radical prostatectomy. Eur Urol 2016; 69: 193–196.
Culp SH, Schellhammer PF, Williams MB . Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. Eur Urol 2014; 65: 1058–1066.
Gratzke C, Engel J, Stief CG . Role of radical prostatectomy in metastatic prostate cancer: data from the Munich Cancer Registry. Eur Urol 2014; 66: 602–603.
Satkunasivam R, Kim AE, Desai M, Nguyen MM, Quinn DI, Ballas L et al. Radical prostatectomy or external beam radiation therapy vs no local therapy for survival benefit in metastatic prostate cancer: a SEER-medicare analysis. J Urol 2015; 194: 378–385.
Fossati N, Trinh Q-D, Sammon J, Sood A, Larcher A, Sun M et al. Identifying optimal candidates for local treatment of the primary tumor among patients diagnosed with metastatic prostate cancer: a SEER-based study. Eur Urol 2015; 67: 3–6.
Heidenreich A, Pfister D, Porres D . Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol 2015; 193: 832–838.
Sooriakumaran P, Karnes J, Stief C, Copsey B, Montorsi F, Hammerer P et al. A multi-institutional analysis of perioperative outcomes in 106 men who underwent radical prostatectomy for distant metastatic prostate cancer at presentation. Eur Urol 2015; 69: 788–794.
Rusthoven CG, Jones BL, Flaig TW, Crawford ED, Koshy M, Sher DJ et al. Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer. J Clin Oncol 2016; 34: 2835–2842.
Acknowledgements
M Moschini is supported by the EUSP Scholarship—European Association of Urology. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The material has not been previously published and has not been submitted for publication elsewhere.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Moschini, M., Soria, F., Briganti, A. et al. The impact of local treatment of the primary tumor site in node positive and metastatic prostate cancer patients. Prostate Cancer Prostatic Dis 20, 7–11 (2017). https://doi.org/10.1038/pcan.2016.52
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/pcan.2016.52
This article is cited by
-
Macroscopic locoregional relapse from prostate cancer: which role for salvage radiotherapy?
Clinical and Translational Oncology (2019)
-
Treatment of M1a/M1b prostate cancer with or without radical prostatectomy at diagnosis
Prostate Cancer and Prostatic Diseases (2017)