Advanced Prostate Cancer
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Radical prostatectomy & bone oligometastases?

New study below.

My RP surgeon told me that his second patient, with lesser cancer than me, was stapled back up after the pathologist found cancer in one of the lymph nodes. I wonder how that man felt when he learned that he still had a prostate. I can't believe leaving it in had a neutral effect on the oucome.

In this study robotic RP was performed on patients with bone mets - "five or fewer hot spots".

"We demonstrated that RARP in the setting of oligometastatic PCa is a safe and feasible procedure and that it improves oncologic outcomes in terms of {progression-free survival} and {cancer-specific survival}."

-Patrick

ncbi.nlm.nih.gov/pubmed/288...

BJU Int. 2017 Aug 21. doi: 10.1111/bju.13992. [Epub ahead of print]

Does robot-assisted radical prostatectomy benefit prostate cancer patients with bone oligometastases?

Jang WS1, Kim MS1, Jeong WS1, Chang KD1, Cho KS1, Ham WS1, Rha KH1, Hong SJ1, Choi YD1.

Author information

1

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

OBJECTIVE:

To investigate perioperative and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in oligometastatic prostate cancer (PCa).

PATIENTS AND METHODS:

We retrospectively reviewed the records of 79 oligometastatic PCa patients treated with RARP or ADT between 2005 and 2015 at our institution. Of these 79 patients, 38 were treated with RARP and 41 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated perioperative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analyzed data using Kaplan-Meier methods with log-rank tests and multivariate Cox regression models.

RESULTS:

RARP-treated patients showed comparable postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than those of ADT-treated patients. PFS and CSS were improved in RARP-treated, compared with ADT-treated, patients (median PFS: 75 vs. 28 months, p = 0.008; median CSS: not reached vs. 40 months, p = 0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio [HR] = 0.388, p = 0.003; CSS: HR = 0.264, p = 0.004).

CONCLUSIONS:

We demonstrated that RARP in the setting of oligometastatic PCa is a safe and feasible procedure and that it improves oncologic outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. However, our study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa. Therefore, to confirm our findings, large, prospective, multicenter studies are required. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS:

Local treatment; Metastatic; Prostate cancer; Radical prostatectomy; Robot-assisted

PMID: 28834084 DOI: 10.1111/bju.13992

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Patrick, I can be real simple sometimes. It just makes intuitive sense, to me, that the fact you have a few Mets, with a bunch of cancer in your Prostate, that debulking by robotic or traditional RP makes sense to me. Within the removed prostate, there may be captured Neuroendocrine cancer cells that have not yet got started to move---these bastards that have no AR receptors, usually attack you later in the disease journey. So if left with a few AR sensitive Mets, this can be dealt with. Getting it out is the best start to the journey, IMO with Oligometastatic PC.

Nalakrats

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I was offered more sensitive scans after garden variety scans showed no metastasis. The presumption being that if the sensitive scans found something then treatment options would be closed off. Why would I want to do that? I refused the new scans. I then went rogue and chose HIFU. I am all in favor of prostate removal or at least aggressive treatment. Just leaving it there makes no sense to a even a dummy like me.

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Where did you have the HIFU? What did it cost. What was the extent (total gland or "focal")? When was it. How did your PSA react?

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Had HIFU last October in San Francisco courtesy of Dr M.J. Lazar. Tumor was contained to one side but the treatment was 'full gland'. $25K. Allowed the 6 month eligard shot administered Aug '16 to time out. PSA was undetectable when measured in May '17.

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I had and RP a little less than 5 years ago and had positive lymph nodes. Age of 57. My prostate was removed at the time and the surgeon at UC Irvine Medical Center told me it really makes sense to do so. I would have gone ballistic if I woke up and found out I still had my prostate including cancer. My Gleason was 3+4 with a tertiary 5 (the nasty stuff.) To date we've been monitoring by PSA. Latest was 0.64 with a doubling time of about 31 months. I saw my MO yesterday and the plan is to get a PSMA PET scan at UCLA when hits 0.7.

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