Cytoreductive Prostatectomy & Oligometastatic PCa.

[pca2004]

New meta-analysis below [1].

The day that I had a prostatectomy, my surgeon had another operation.  The man was found to have cancer in a lymph node, so was stapled-up with his prostate intact.  This was in 2004 & debulking was considered to be pointless since the patient would be receiving systemic therapy.  I believe that the situation has changed somewhat over the years. 

When the concept of oligometastatic PCa began to be accepted, with the potential for cure, I assume that removal or radiation of an intact prostate would be part of standard treatment.  However, for the following survival statistics to be meaningful, oligometastic controls would have had their mets treated – but not their intact prostates. Seems odd & maybe my reading is incorrect. 

“The oncologic outcomes of cytoreductive prostatectomy (CRP) in oligometastatic prostate cancer (OmPCa) are still controversial. Therefore, we conducted a systematic review and meta-analysis on the oncologic outcome of CRP in OmPCa.” 

“A total of 11 studies (929 patients), 1 randomized controlled trial (RCT) and 10 non-RCT studies, were included in the final analysis.” 

“In {progression-free-survival}, in {the randomized controlled trial}, HR=0.43 … was shown statistically significant, but in {the non-randomized controlled trials}, HR=0.50 ... there was no statistical difference.  

“…  time to {castration-resistant prostate cancer} was statistically significant in the {cytoreductive prostatectomy} group in all analyses ({randomized controlled trial}; HR=0.44 …) ({non-randomized controlled trials}; HR=0.64 …).  

“… {cancer-specific-survival} was not statistically different between the two groups (HR=0.63 …).  

“… {overall-survival} showed better results in the {cytoreductive prostatectomy}  group in all analyses ({randomized controlled trial}; HR=0.44 …) ({non-randomized controlled trials}; HR=0.59 …).” 

“Overall” survival trumps the others imo. 

-Patrick [1]  

pubmed.ncbi.nlm.nih.gov/373...

  

[TeleGuy]

Patrick,

I think where you express surprise “!!!” you are forgetting that they are comparing randomized and non-randomized trials and they are saying that BOTH types of studies show a favorable HR of 0.63. So no matter how you study it (RCT or not), you do better on CSS with oligometastatic disease if you debulk.

[pca2004 in reply to TeleGuy]

Oops! - yes, thanks! (corrected) -Patrick

[cujoe]

Patrick,

Another intesting find. FWIW, When I was headed into my RALP, I was told that I would be treated like the patient in front of your surgery; i.e., PCa in lymph node(s) would result in abandoning the procedure and later treatment with RT.

When I was scheduled for my intial diagnostic MRI, I had forwarned my Surgical Oncologist that I had CLL and, as a result, my lymph nodes might "light-up' on the scan. I suggested that contrast agent selection might be useful in discriminating CLL, but never knew if that resulted in any change from the one normally used for PCa scans.

However, when I was being prepped for sugery, he reminded me of the potential for a shortened surgery and said they would biopsy several lymph nodes and proceed or stop based on the results. Five lymph nodes were biospied and all were positive for CLL/SLL and none for PCa, so the prosatectomy proceeded as planned. With the poor pathology from the final biopsy on the removed prostate, I now consider removing the "mothership" to be one of the reasons I have not advanced more quickly. Removing the prostate is the most effective de-bulking one can do. (Just my n=1 opinion.)

Ciao - K9 terror