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Review
. 2023 Mar 1;33(2):168-171.
doi: 10.1097/MOU.0000000000001068. Epub 2023 Jan 12.

Cytoreductive radical prostatectomy: who benefits from the surgical approach?

Axel Heidenreich  1 , Pia Paffenholz, David Pfister, Constantin Rieger
Affiliations
Review

Cytoreductive radical prostatectomy: who benefits from the surgical approach?

Axel Heidenreich et al. Curr Opin Urol. .

Abstract

Purpose of review: Local treatment in oligometastatic prostate cancer patients is associated with improved survival. Nevertheless, in term of surgery, cytoreductive radical prostatectomy has no level of evidence 1 and is an individual treatment approach. We reviewed the recent literature to highlight parameters for selecting patients for a surgical approach.

Recent findings: Retrospective data on oncologic outcome for cytoreductive prostatectomy are confirmed. We identified several parameters that help to select patients for surgery. Patients with a favorable prostate-specific antigen (PSA) decline after androgen deprivation therapy (ADT) have excellent oncologic long-term control. Circulating tumor cells (CTC's) are frequently analyzed in more advanced prostate cancer. In case of C-reactive protein (CRP) at least a longer interval to develop castration resistant prostate cancer (CRPC) is shown in case of low CTC count at time of surgery. Nutrition status analyzed as the hemoglobin, albumin, lymphocyte, and platelet (HALP)-score is of significant value in demonstrating an effect of CRP.

Summary: From retrospective findings we have several clinical and basic science parameters to select patients for CRP. PSA at the time of surgery is the most frequently analyzed one, whereas CTC and HALP-score are promising tools to select patients that need to be validated.

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References

    1. Boeve LMS, Hulshof M, Vis AN, et al. Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD Trial. Eur Urol 2019; 75:410–418.
    1. Parker CC, James ND, Brawley CD, et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 2018; 392:2353–2366.
    1. Heidenreich A, Fossati N, Pfister D, et al. Cytoreductive radical prostatectomy in men with prostate cancer and skeletal metastases. Eur Urol Oncol 2018; 1:46–53.
    1. Heidenreich A, Pfister D, Porres D. Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol 2015; 193:832–838.
    1. Gandaglia G, Fossati N, Stabile A, et al. Radical prostatectomy in men with oligometastatic prostate cancer: results of a single-institution series with long-term follow-up. Eur Urol 2017; 72:289–292.

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