Surgery in metastatic prostate cancer: a pilot study
نویسنده
چکیده
www.trendsinmenshealth.com TRENDS IN UROLOGY & MEN’S HEALTH MAY/JUNE 2017 Prostate cancer is the most common cancer and the second most frequent cause of cancer death in Western men.1 Recent data from the STAMPEDE trial suggest a median survival of just 42 months in the control arm of metastatic men.2 Current standard care consists of androgen deprivation therapy (ADT) +/− chemotherapy based on the STAMPEDE and CHAARTED studies.2,3 However, there are emerging data suggesting that radical therapy directed at the prostate impacts survival, especially in those with limited metastatic burden, defined as 1–3 skeletal lesions without any visceral metastases (oligometastases).4,5 Many men also suffer symptomatic disease progression and eventually require palliative surgical intervention, which is less frequent in those treated with initial radical prostatectomy compared to systemic therapy alone.6,7 There are convincing data to support the concept of radical therapy in many metastatic cancers, including ovarian cancer, renal-cell carcinoma, glioblastoma, peritoneal carcinomatosis from gastrointestinal cancer, and colon cancer.4 Hence, there is a rationale to examine whether it has a role in prostate cancer. Further, there is a strong biological rationale for considering a radical approach to metastatic prostate cancer.4 The ‘seed and soil’ hypothesis postulates that a receptive micro-environment (the ‘soil’) allows disseminating malignant cells (the ‘seed’) to engraft into and form metastases, with soil development thought to be driven by factors secreted by the primary tumour. There is evidence that the primary tumour can seed to distant sites and that cancer cells at those end-sites can further seed the primary Surgery in metastatic prostate cancer: a pilot study
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تاریخ انتشار 2017