"The potential oncological benefit for radical treatment in the setting of oligometastatic prostate cancer has been under investigation and is frequently discussed."
"Overall, 18 studies reporting on local treatment in metastatic prostate cancer patients were identified (14 original articles, three brief correspondences and one letter to the editor)."
"All but one study concluded a survival benefit for local treatment in the metastatic setting."
The potential oncological benefit for radical treatment in the setting of oligometastatic prostate cancer has been under investigation and is frequently discussed. We carried out a systematic review of English language articles using the Medline database (January 2000 to May 2017) to identify studies reporting local treatment in men with metastatic prostate cancer at diagnosis. Primary end‐points were oncological outcomes, such as cancer‐specific and overall mortality. Secondary end‐points were non‐oncological outcomes, such as complications, operating room time, blood loss or length of hospital stay. Two independent authors reviewed and extracted all search results. Overall, 18 studies reporting on local treatment in metastatic prostate cancer patients were identified (14 original articles, three brief correspondences and one letter to the editor). All of them were retrospective; one partly included prospective data. All studies addressed oncological outcomes, 16 compared local treatment with no‐local treatment and 14 adjusted for confounders using multivariable regression models. All but one study concluded a survival benefit for local treatment in the metastatic setting. Due to heterogeneity of available data, a representative meta‐analysis could not be carried out. Five studies reported non‐oncological outcomes. Although local treatment in metastatic prostate cancer appears to be feasible, its oncological effect remains unclear due to high susceptibility of available studies to significant selection bias.
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pjoshea13
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I had a very interesting conversation with my new MO at MSK. He said MSK now offers local treatment (combination of RP and RT) to all eligible patients with Mets. I seem to remember that someone here also mentioned that’s the routine at MDA as well. Looks like we are entering a new paradigm even before the results of the clinical trials are out.
I have oligometastatic PCa - today is actually the 3rd anniversary of my diagnosis. PSA was 227, 1 bone met in T 8 vertebra, Gleason 4+4=8, age 53 at diagnosis. Had radiation to vertebra, early chemo, been on Lupron since diagnosis, started Zytiga in December. PSA is currently undetectable
I go to MD Anderson and am having a radical prostatectomy on July 11th. This is a new approach for them and still not considered the ‘standard of care’. My wife and I decided to be as aggressive as possible with my treatment and we are grateful our doctor is too. We pray this approach works ... at least we will know we have done everything possible.
I was diagnosed at the U of M (Minnesota) in Nov of 2015 and my uro there was pretty cutting edge it appears. I had evidence of lymph node involvement but he proposed multi-modal treatment with a month of ADT to shrink the tumor, then open RP, continued ADT and adjuvant RP. I appreciate that he was willing to try this aggressive approach. I was 50 at diagnosis.
Not promising as a whole however not all guys in these studies ended up on the bad side. There are exceptions to every rule and without trying a man will never know. Age, health, genetics and medical team are huge factors in every outcome. There are not enough men in any given treatment analysis that share in the same overall beginning diagnosis to know anything for sure.
My point is, guys don't let stats cloud your head. There are no guarantees with any treatment option however not trying is a guaranteed outcome. We all know cancer advances. Find a specialist in a major hospital setting and try and curve the odds.
This is one of those problems for which I think we really need a randomized prospective trial, i.e., a trial in which men with metastatic disease are randomly assigned either to get surgery or not, and then carry out the treatment (or not as the case may be.) Note that the abstract said:
"All of them were retrospective; one partly included prospective data."
And later:
"Although local treatment in metastatic prostate cancer appears to be feasible, its oncological effect remains unclear due to high susceptibility of available studies to significant selection bias."
"Selection bias" means that the men selected for surgery may have been different from the ones not offered surgery. It would not be at all surprising if the doctors carried out the surgeries on healthier men who had the least aggressive and developed disease. They are the men best able to recover quickly from surgery and the ones that would give the surgeons the most grounds for optimism. Of course those men would have better outcomes down the road, whether or not the surgery helped.
I'm not saying that the surgery doesn't help. It very well might. I'm just agreeing with Ron. We really don't have enough data to form a strong conclusion one way or another.
Add univ. Of Chicago to list of places that will do local treatment. I’m set up for radiation to Mets and prostate. The funny part is I had to listen to two doctors tell me there was no solid evidence that this would work. Wink Wink
There are clinical trials ongoing for addition of local treatments. But if I'm not mistaken the results would be 3-5years out. The real question is what to do now, and how to look at the balance of risk, when we do not have the "proof". It's a gray area. We read the scientific papers (for and against), lean on the intuition of our medical team, and then listen to our inner voice. At the end, each of us needs to make a decision based on imperfect information available to us. Not doing a local therapy where you could, is also a decision.
There are almost 500 PubMed hits for<debulking[title] cancer> & almost 5,000 for <debulking cancer>. It seems that the issue of debulking has been faced & decided for many cancer types.
With RP, one's feeling that debulking must be beneficial has to be strong enough to counter the knowledge of the certainty that there will be some impact on sexual function.
It's not easy for anyone and especially the guys that fall into the younger group in this area. I was diagnosed at 46 and for the most part my function ended with the Lupron. I do feel cheated in some ways but without a RP a guy is still looking at the effects HT. The effects of HT for me is no quality of life either. Dealing with cognitive function, muscle, bone and fighting weight gain along with ED is brutal and nothing to look forward to either.
Yup, I'm a fraction of what I was in the bedroom but I gave myself the best chance I could to live and see my children grow, land a few more fish and still experience some wonders of this world. I feel blessed that I have overcame what many doctors told me was impossible. Time will tell but even if it comes back I still added years to my life by taking the route I did. I am convinced along with my doctors that with the amount of cancer I had without a RP / lymphadenectomy combined with early chemo there is no way I would have no evidence of disease today.
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Radiation of metastases now makes more sense?
