Contemporary role of palliative cystoprostatectomy or pelvic exenteration in advanced symptomatic prostate cancer

Published on Jul 1, 2021in World Journal of Urology4.226
· DOI :10.1007/S00345-020-03493-5
G. Gandaglia3
Estimated H-index: 3
(UniSR: Vita-Salute San Raffaele University),
Alexander Kretschmer19
Estimated H-index: 19
(LMU: Ludwig Maximilian University of Munich)
Sources
Abstract
OBJECTIVE To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). PATIENTS AND METHODS Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien-Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. RESULTS Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3-41) for the entire cohort with a median survival of 15 months (95% CI 10.1-19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62-17.23, p = 0.164). CONCLUSION Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome.
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OBJECTIVE: To retrospectively evaluate the surgical, symptomatic and oncological outcome following pelvic extenteration surgery (PES) in men with significant intrapelvic complications of locally advanced castration-sensitive (CSPC) and castration resistant prostate cancer (CRPC). PATIENTS AND METHODS: 103 patients with locally advanced progressive and symptomatic CS/CRPC underwent PES: radical cystoprostatectomy in n=71 (68.9%), radical prostatectomy with continent vesicostomy in n=9 (8.7%), tot...
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LHRH-Analoga oder Antagonisten stellen das Mittel der Wahl beim metastasierten Prostatakarzinom dar. Trotz anfanglich meist guten Ansprechens hat diese Therapie nur einen palliativen Charakter und fuhrt unweigerlich nach durchschnittlich 1,5 bis 2,5 Jahren zur Entwicklung eines kastrationsresistenten Prostatakarzinoms (KRPCA). In diesem Fall stehen neben der klassischen Taxan-basierten Chemotherapie, die sekundare Hormonablation mit Enzalutamid und Abirateron, Sipuleucel T sowie Radium 223 als n...
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Abstract Background Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution. Methods Using hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TU...
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We reviewed the current salvage methods for patients with local recurrent prostate cancer after primary radiotherapy (RT), using a search of relevant Medline/PubMed articles published from 1982 to 2008, with the following search terms: ‘radiorecurrent prostate cancer, local salvage treatment, salvage radical prostatectomy (RP), salvage cryoablation, salvage brachytherapy, salvage high-intensity focused ultrasound (HIFU)’, and permutations of the above. Only articles written in English were inclu...
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Patienten mit lokal fortgeschrittenen Prostatakarzinomen (PCA) sind oft durch lokale Symptomatik und deren Komplikationen oder Therapie deutlich in ihrer Lebensqualitat eingeschrankt. Gleichzeitig betragt die Lebenserwartung meist mehrere Jahre, wobei Urologen und Onkologen dazu tendieren, die Lebenserwartung ihrer Patienten zu unterschatzen. Die Zystektomie mit der Indikation eines lokal fortgeschrittenen PCA ist bezuglich der Komplikationsraten und der Art der Komplikationen ein vertretbarer E...
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