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Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense?

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Abstract

Purpose

Surgical removal of the primary tumor in metastatic prostate cancer (mPCa) is becoming a hotly debated issue. The purpose of this review was to summarize the current knowledge on cytoreductive radical prostatectomy (cRP) in this setting.

Materials and methods

We performed a non-systematic Medline/PubMed literature search of articles published in the field between January 2000 and April 2015.

Results

Cytoreductive surgery has demonstrated its benefit in various malignancies with a solid biological rationale to justify its assessment in mPCa. cRP appears as a safe and feasible procedure in expert hands and well-selected patients. A growing body of evidence suggests a survival benefit for patients undergoing cRP as a part of a multimodal approach compared to those treated with systemic treatment alone. Nevertheless, little is known about the best clinical and tumor characteristics for the selection of patients most likely to benefit from cRP. The current literature is based on retrospective studies with small cohorts and limited follow-up or large uncontrolled population-based studies.

Conclusions

Data from various other malignancies together with the biological rationale and preliminary results in PCa suggest that cytoreductive surgery may be an option in some mPCa patients. The lack of randomized controlled trials and the low level of evidence in the current literature preclude any firms conclusion on the benefit of cRP in mPCa. Ongoing phase II and future phase III studies are mandatory to define the exact role of cRP in mPCa and to identify the patients who are most likely to benefit from cRP.

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Acknowledgments

R.M. was supported by the Scholarship Foundation of the Republic of Austria—OeAD and by the EUSP Scholarship—European Association of Urology.

Authors’ contribution

Romain Mathieu, Stephan M. Korn, Shahrokh F. Shariat involved in protocol/project development, and data collection or management. Romain Mathieu, Stephan M. Korn, Shahrokh F. Shariat, Karim Bensalah, Gero Kramer contributed to data analysis. Romain Mathieu, Stephan M. Korn, Shahrokh F. Shariat, Karim Bensalah, Gero Kramer involved in manuscript writing/editing.

Author information

Authors and Affiliations

  1. Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria

    Romain Mathieu, Stephan M. Korn, Gero Kramer & Shahrokh F. Shariat

  2. Department of Urology, Rennes University Hospital, Rennes, France

    Romain Mathieu & Karim Bensalah

  3. Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

    Shahrokh F. Shariat

  4. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

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  1. Romain Mathieu
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Correspondence to Shahrokh F. Shariat.

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The authors declare that they have no conflict of interest.

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This study was carried out in accordance with the principles of the ethical standards.

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Mathieu, R., Korn, S.M., Bensalah, K. et al. Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense?. World J Urol 35, 567–577 (2017). https://doi.org/10.1007/s00345-016-1906-3

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  • DOI: https://doi.org/10.1007/s00345-016-1906-3

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