Professor Li Yonghong: Tumor-reducing treatment of primary tumor of metastatic prostate cancer

The prognosis of patients with metastatic prostate cancer is not good, and optimizing their treatment is gradually becoming a hot issue in the field of urinary tumors
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In recent years, studies have found that primary cytoreductive surgery can improve the survival rate of patients with metastatic prostate cancer, but there is still much controversy regarding the application of primary cytoreductive surgery
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The Symposium on Urology and Oncology of Guangdong Medical Association was held in Guangzhou on November 6
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During the conference, Professor Li Yonghong from the Department of Oncology and Urology, Sun Yat-sen University introduced the treatment of primary tumor reduction for metastatic prostate cancer
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Development history of cytoreductive radical prostatectomy In a randomized controlled study in 2002, 1286 patients with metastatic prostate cancer received bilateral orchiectomy combined with placebo or flutamide, compared with those who had not previously received radical prostatectomy.
Compared with patients undergoing surgery, the risk of death of patients who had undergone surgery was significantly reduced (HR=0.
77)
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Subsequently, a number of retrospective and prospective studies continued to emerge
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A number of retrospective studies have confirmed that radical prostatectomy (CRP) may bring survival benefits to patients with metastatic prostate cancer, and local symptoms will also be relatively reduced
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However, there is still a lack of high-level evidence-based medical evidence for the surgical treatment of metastatic prostate cancer
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In clinical practice, the choice of cytoreductive radical prostatectomy should be cautious
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It is mainly manifested in the following aspects: Be cautious about the published research data.
Most of the studies of radical prostatectomy are retrospective studies.
Generally speaking, patients with relatively young age, good general condition, few comorbidities, and low tumor metastasis burden will Undergoing radical prostatectomy, but the general condition is poor; and patients with large tumor burden generally only receive endocrine therapy
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In fact, the general condition of patients who can undergo surgery is relatively good, and even if they have not received surgery, the prognosis is relatively good
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Some prospective studies have a small number of cases and often choose patients with oligometastasis.
Most studies only publish progression-free survival (PFS), and there is no overall survival (OS) data
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Several large prospective randomized controlled clinical studies are still in progress
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Identifying patients who may benefit The US SEER database collected case data of 15,501 patients with metastatic prostate cancer, and established a three-year mortality risk model based on the patient’s age, comorbidity, PSA level, Gleason score, and TNM staging
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The results show that prostate cancer patients diagnosed with M1 can benefit from local treatments including surgery, but only those with low tumor risk and good physical condition
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Two large prospective studies, the STEMPEDE study and the HORRAD study, evaluated the efficacy of radiotherapy combined with androgen deprivation therapy (ADT) in patients with metastatic prostate cancer
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The results show that indiscriminate prostate cancer radiotherapy does not improve the survival of patients with metastatic prostate cancer.
The results of both studies suggest that the combined prostate cancer radiotherapy regimen only has a survival benefit in the low metastatic tumor load group
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It can be seen from the population included in most randomized controlled studies that the population that may benefit from cytoreductive surgery is still patients with oligometastasis or generally in good condition
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The definition of oligometastatic prostate cancer that needs to be weighed against the trauma that may be caused by surgery is still unclear.
General studies believe that the use of conventional imaging methods to find metastases <5 can be regarded as oligometastatic prostate cancer
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Studies have shown that the complications of prostate cancer surgery for metastatic prostate cancer and limited-stage prostate cancer are equivalent, but most of the patients enrolled in radical prostatectomy have a low partial stage (≤T3 stage) and good general conditions.
Patients with oligometastasis
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If the tumor is partially elevated, the difficulty of the operation will increase, the rate of local residual and positive margins will increase, and the risk of bleeding, intestinal injury, postoperative urinary incontinence, and the recurrence and progression of local prostate tumors will increase the risk of symptoms
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In order to reduce the risk of surgical complications, it is necessary to select patients with better general conditions and lower partial stages
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Surgery is not the only option-a large study of radiotherapy and cryoablation shows that radiotherapy + ADT can also be used as one of the treatment options for patients with newly diagnosed metastatic prostate cancer
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A recent study published by Professor Li Yonghong's team showed that cryoablation + ADT can significantly prolong the PFS of patients compared with ADT alone, and the results of OS are under further follow-up
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Summary The treatment of primary tumor cytoreduction for metastatic prostate cancer may prolong survival and reduce local symptoms; published research data must be viewed objectively; patients who may benefit must be identified; the trauma that may be caused by surgery must be weighed; surgery and It is not the only option; it is recommended to adopt the method of clinical research and cautiously carry out radical prostatectomy
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