Is surgery useful in advanced prostate cancer?

This study looked at the effect of cytoreductive radical prostatectomy (CRP) on advanced prostate cancer following androgen deprivation therapy (ADT).

Though the majority of men do not die from prostate cancer, some forms can be fast growing and can potentially spread to other organs (advanced or metastatic cancer). One of the treatment options for advanced or metastatic prostate cancer is androgen deprivation thereapy (ADT). This is treatment to reduce the production of androgens (male sex hormones usually required for cancer growth) or inhibit their effect on cancer cell growth. 

Another form of treatment is cytoreductive radical prostatectomy (CRP). This is a local therapy, meaning that it targets the tumor and the area near it. It involves surgery to remove the prostate tumor in a bid to increase patient survival and improve their response to future medical treatments by removing as many cancer cells as possible.

Though surgery is not typically undertaken in advanced prostate cancer, recent research has shown that cancer cells can remain in the prostate after extensive treatment with ADT. Studies have highlighted the potential benefit of CRP versus ADT alone in treating prostate cancer.

The authors aimed to evaluate how feasible an approach including both ADT and CRP would be in prostate cancer patients where some cancer has spread to the bones. 

The study involved two groups. Group A included 23 patients with prostate cancer and low volume bone metastases (a small amount of tumor cells have attached to the bone). Patients received ADT for 6 months. Those who achieved a prostate specific antigen (PSA – a protein usually elevated in prostate cancer) level of < 1.0ng/ml after ADT treatment underwent CRP. Group B (control group) contained 38 patients with prostate cancer that were treated with ADT only.

The average time from the beginning of the study to castration-resistant prostate cancer (where patients become resistant to ADT and the cancer progresses despite treatment) was 40 months for Group A and 29 months for Group B.

Group A experienced significantly better progression-free survival rates (time after treatment where the disease does not get worse) of 38.6 months versus 26.5 months for Group B. Cancer-specific survival rates (percentage of people surviving cancer in the absence of death by other means) of 95.6% were found in Group A in comparison to 84.2% in Group B.

11 patients (29%) from Group B underwent further surgery as a result of PCA progression compared to none in group A. 33.3% of Group B patients developed urinary tract problems and various other complications following treatment. 

CRP is a feasible treatment with the potential to improve survival rates in metastatic prostate cancer patients who respond well to initial ADT.

This study was the first study on CRP and ADT treatment and involved small patient numbers and relatively short follow-up times. Further studies are recommended. 

If you are contemplating cytoreductive radical prostatectomy, discuss the potential benefits and drawbacks with your doctor.