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A comprehensive review of contemporary role of local treatment of the primary tumor and/or the metastases in metastatic prostate cancer

Biomed Res Int. 2014;2014:501213

Biomed Res Int. 2014;2014:501213

Abstract

To provide an overview of the currently available literature regarding local control of primary tumor and oligometastases in metastatic prostate cancer and salvage lymph node dissection of clinical lymph node relapse after curative treatment of prostate cancer. Evidence Acquisition. A systematic literature search was conducted in 2014 to identify abstracts, original articles, review articles, research articles, and editorials relevant to the local control in metastatic prostate cancer. Evidence Synthesis. Local control of primary tumor in metastatic prostate cancer remains experimental with low level of evidence. The concept is supported by a growing body of genetic and molecular research as well as analogy with other cancers. There is only one retrospective observational population based study showing prolonged survival. To eradicate oligometastases, several options exist with excellent local control rates. Stereotactic body radiotherapy is safe, well tolerated, and efficacious treatment for lymph node and bone lesions. Both biochemical and clinical progression are slowed down with a median time to initiate ADT of 2 years. Salvage lymph node dissection is feasible in patients with clinical lymph node relapse after local curable treatment. Conclusion. Despite encouraging oncologic midterm results, a complete cure remains elusive in metastatic prostate cancer patients. Further advances in imaging are crucial in order to rapidly evolve beyond the proof of concept.

Cooment from Henk van der Poel: Although timely, the topic of local therapy in metastasized prostate cancer is not without discussion. Incidental reports showed rapid metastases progression after local (surgical) therapy (Ceelen et al., Crit Rev Oncol Hematol. 2014 Jan;89(1):16-26). The review by Aoun and Velthoven warns against expectations of cure in treating men with metastasized PCA. Careful analysis in comparative studies seems mandatory before uninformed widespread use is advocated.

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