EURURO Vol. 72 No. 2

289 320

Prostate Cancer
Radical Prostatectomy in Men with Oligometastatic Prostate
Cancer: Results of a Single-institution Series with Long-term
Follow-up
Giorgio Gandaglia Nicola Fossati Armando Stabile Marco Bandini
Patrizio Rigatti Francesco Montorsi Alberto Briganti
a Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; bVita-Salute San Raffaele University, Milan, Italy; cDepartment of
Urology, Advanced Urotechnology Center, Scientific Institute ‘‘Istituto Auxologico Italiano,’’ Milan, Italy
Radical prostatectomy (RP) was historically restricted to
patients with localized prostate cancer (PCa), and only in
the past few years[1_TD$DIFF] this approach[7_TD$DIFF] has been considered for
advanced or node-positive disease . More recently, a
potential oncologic benefit associated with local treatment
has been hypothesized, even in the oligometastatic setting
. Metastatic PCa represents a heterogeneous disease
in which selected patients with a low number of nonvisceral
metastases might have a favorable oncological profile and
thus might benefit from removal of the primary tumor
. With the lack of data from prospective randomized
trials, previous studies tried to retrospectively assess the
ava ilable at
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Article info
Article history:
Accepted August 17, 2016
Associate Editor:
James Catto
Keywords:
Radical prostatectomy
Metastatic
Prostate cancer
Local treatment
Cancer-specific mortality
Abstract
In the absence of data from randomized trials, the role of local treatment in metastatic
prostate cancer (PCa) is gaining interest. Our study aimed to assess perioperative and
long-term oncologic outcomes of radical prostatectomy (RP) in a selected cohort of
11 patients with oligometastatic disease treated with RP and extended pelvic lymph
node dissection between 2006 and 2011. Oligometastatic disease was defined as the
presence of five or fewer bone lesions at bone scan with or without suspicious pelvic or
retroperitoneal nodal involvement at preoperative imaging. The minimum follow-up for
survivors was 5 yr. Perioperative outcomes, clinical progression, and cancer-specific
mortality (CSM) were evaluated. Median age was 72 yr. Median operative time, blood
loss, and length of hospitalization were 170 min, 750 ml, and 13 d, respectively. Overall,
two patients (18%) experienced grade 3 complications in the postoperative period, and
eight (73%) received blood transfusions. Overall, 10 (91%) and 8 (73%) patients had
lymph node invasion and positive surgical margins, respectively. Adjuvant androgen
deprivation therapy was administered to 10 patients (91%). Median follow-up for
survivors was 63 mo. The 7-yr clinical progression- and CSM-free survival rates were
45% and 82%, respectively. Our findings support the safety and effectiveness of RP in a
highly selected cohort of PCa patients with bone metastases and long-term follow-up.
Patient summary: We evaluated the outcomes of patients with oligometastatic prostate
cancer treated with radical prostatectomy with a minimum of 5-yr follow-up. This
surgical procedure performed with a multimodal approach might represent a safe and
feasible option in selected men and provide acceptable oncologic outcomes at long-term
follow-up.
# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Division of Oncology/Unit of Urology, URI, San Raffaele Hospital, Milan, Italy.
Tel. +39 0226437286.
E-mail address: (A. Briganti).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.