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Prostate Cancer: Localized: Surgical Therapy II (PD19): Podium 19: Saturday, September 11, 2021

PD19-08 A SYSTEMATIC REVIEW OF CYTOREDUCTIVE PROSTATECTOMY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH OLIGOMETASTATIC PROSTATE CANCER

Morozov, Andrey; Chuvalov, Leonid; Enikeev, Mikhail; Taratkin, Mark; Enikeev, Dmitry

doi: 10.1097/JU.0000000000002008.08
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INTRODUCTION AND OBJECTIVE:

Local treatment in generalized disease is a controversial strategy in terms of cancer control and complications. The aim of our systematic review is to analyze the available data on cytoreductive prostatectomy (CRP) in order to understand what role this should play in treatment strategy.

METHODS:

We have performed a systematic literature search using 3 databases (Medline (PubMed), Scopus, and Web of Science) based on the following search query: “prostate cancer” AND (“оligo metast*” OR “bone metast*”) AND (RPE OR prostatectomy OR surgery OR “cytoreductive prostatectomy”) following PRISMA guidelines. The detailed search strategy and review protocol has been published in Prospero (ID CRD42020192328). The scope of the review according to the PICO process (Patient, Intervention, Comparison, Outcomes) is as follows: P – patients with oligometastatic prostate cancer; I – cytoreductive prostatectomy; C – conventional treatment (ADT, chemotherapy), or local radiotherapy; O – oncological outcomes (CSS, progression-free survival (PFS), overall survival (OS)), functional outcomes (urinary incontinence and erectile function (EF) rates), complications. The primary outcomes were the oncological results: cancer-specific survival (CSS), progression-free survival (PFS), overall survival (OS). The secondary outcomes were complication rates and functional results (urinary continence).

RESULTS:

In all the studies OS was better or at least comparable in the groups with CRP and no local treatment (NLT). The most essential benefit from CRP was noted by Culp et al. (5-year OS 67.4% for RP vs 22.5 for NLT). CSS showed the same trend. Positive surgical margin rate ranged from 28.6% up to 100%. Urinary continence in CRP was significantly lower, than in RP for localized PCa, 57.4% vs 90.8%, p<0.0001. But severe incontinence occurred seldom (2.5–18.6%). Between 50% and 84.6% of the patients were completely continent. Total complications rate after CRP differed widely, from 7–8.8% to 41.2–43.6%. Rates of grade 1 and 2 events prevailed. The patients on ADT alone also showed a considerable number of complications, varying from 5.9% to 57.7%. A significant proportion (26.8%-44.7%) of them required interventions due to local progression.

CONCLUSIONS:

CRP improves medium-term cancer control in patients with oligometastatic PCa. This surgery results in what we believe to be an acceptable complication rate with a slightly impaired urinary continence as compared to RP for a localized disease.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.