Cytoreductive surgery for Oligometastatic PCa.

[pjoshea13]

New meta-analysis below [1].

"... ten studies were identified that met the conclusion {inclusion?} criteria. The total number of samples was 804; 449 patients underwent cytoreductive surgery, and 355 patients underwent endocrine therapy ...

"... we found that between cytoreductive surgery and endocrine therapy, a significant difference existed in overall survival (HR = 0.635...), cancer-specific survival (HR = 0.407 ...), and progression-free survival (HR = 0.489 ...), while there were no significant difference in progresses to castration-resistant prostate cancer"

"The cytoreductive surgery held advantages in overall survival, cancer-specific survival, and progression-free survival. Therefore, compared with endocrine therapy, cytoreductive surgery could be a more suitable approach in treating oligometastatic prostate cancer."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/340...

Review World J Surg Oncol

. 2021 May 29;19(1):160. doi: 10.1186/s12957-021-02265-8.

The efficacy of cytoreductive surgery for oligometastatic prostate cancer: a meta-analysis

Bisheng Cheng 1 , Shuchao Ye 1 , Peiming Bai 2

Affiliations collapse

Affiliations

1 Zhongshan Hospital Affiliated to Xiamen University, Xiamen, 361001, China.

2 Zhongshan Hospital Affiliated to Xiamen University, Xiamen, 361001, China. [e-mail].

PMID: 34051809 DOI: 10.1186/s12957-021-02265-8

Abstract

Backgrounds: At present, the application of tumor reduction surgery in oligometastatic prostate cancer has aroused extensive discussion among urologists, but clinicians have not reached a consensus on this issue. The purpose of this study was to evaluate the effect of cytoreductive surgery for patients with oligometastatic prostate cancer by meta-analysis.

Methods: All relevant studies were systematically searched through The Cochrane Library, PubMed, Web of Science, EMBASE, and China Biomedical Literature Database (CBM) up to December 2019. All the previous clinical studies on the comparison of long-term efficacy between the cytoreductive surgery group and the endocrine therapy group were included in the search. The included studies were analyzed using Stata ver.14.0. The research has been registered on PROSPERO website with the registration number of crd42021224316. The relevant registration information can be obtained from the website: crd.york.ac.uk/prospero .

Results: The case presentation is as follows: ten studies were identified that met the conclusion criteria. The total number of samples was 804; 449 patients underwent cytoreductive surgery, and 355 patients underwent endocrine therapy, and we conducted a meta-analysis of studies to compare the prognosis of endocrine therapy and cytoreductive surgery for treating prostate cancer. After all the studies were analyzed, we found that between cytoreductive surgery and endocrine therapy, a significant difference existed in overall survival (HR = 0.635, 95% CI 0.443-0.908, P = 0.013), cancer-specific survival (HR = 0.407, 95% CI 0.243-0.681, P = 0.001), and progression-free survival (HR = 0.489, 95% CI 0.315-0.758, P = 0.001), while there were no significant difference in progresses to castration-resistant prostate cancer (HR = 0.859, 95% CI 0.475-1.554, P = 0.616).

Conclusion: The cytoreductive surgery held advantages in overall survival, cancer-specific survival, and progression-free survival. Therefore, compared with endocrine therapy, cytoreductive surgery could be a more suitable approach in treating oligometastatic prostate cancer.

Keywords: Cytoreductive surgery; Endocrine therapy; Meta-analysis; Oligometastatic; Prostate cancer.

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[cesanon]

Interesting.

I never heard of Cytoreductive surgery before.

"Cytoreductive surgery (CRS) is a surgical procedure that aims to reduce the amount of cancer cells in the abdominal cavity for patients with tumors that have spread intraabdominally (peritoneal carcinomatosis). It is often used to treat ovarial cancer but can also be used for other abdominal malignancies.

CRS is often used in combination with hyperthermic intraperitoneal chemotherapy (HIPEC), for some cancer diagnosis it considerably increases life expectancy and reduces the rate of cancer recurrence.

Its main developer was Paul Sugarbaker which is known for the instauration of cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy,[1] or HIPEC, a treatment alternately referred to as the Sugarbaker Procedure.[2][3]"

en.wikipedia.org/wiki/Cytor...

[6357axbz]

This doesn’t seem to mention RT to prostate. Am I mistaken or is this a debulking via RP versus hormone therapy only, no debulking?

[pjoshea13 in reply to 6357axbz]

Surgical debulking of the prostate itself.

[6357axbz in reply to pjoshea13]

Yes, it’s comparing surgical debulking to hormone therapy only.

[MateoBeach]

They don’t say what the characteristics (inclusion criteria) for the 10 studies they used for this. How many if any were prospectively randomized .(none?)It is an exercise in meta-analysis. But a meta-analysis can reach no conclusions stronger than the quality of data included. Therefore I would not trust their conclusion based on this. See my recent post and links on the strengths and weaknesses of meta-analysis, a great tool when used the right way.

[Hidden]

Based upon the definition provided by one of the posters, I am inferring from the article that this surgery does not involve the prostate but is directed at metastases somewhere in the abdomen.

Am I incorrect?