Surgery for advanced prostate cancer?

Surgery for advanced prostate cancer?

Sooner rather the exception, but today certainly an option. Thus, new investigations can be summarized, which were presented at the German Association of Urology congress in 2009.
From locally advanced prostate cancer is when the tumor is no longer limited to the prostate (locally), but the prostate capsule has broken through and is eventually grown into the seminal vesicles or other adjacent organs (T3-4, to the TNM system s growth and spread of prostate cancer ). In contrast, we group under advanced prostate cancer usually locally advanced tumors and those tumors together, infected regardless of their local spread regionären the (local) lymph nodes (N1 or N +). As a combination of treatment is often used in such cases,radiotherapy and hormone therapy recommended. But a radical prostatectomy (RPE) can being:

It was pointed out (Hammerer) that a lymph node involvement earlier often a contraindication (contraindication) for RPE was. However, according to new findings could be beneficial, if only up to 3 lymph nodes. Positive evidence would be there for an extended lymphadenectomy (lymph node dissection) and adjuvant (accompanying) hormonal and radiation therapy.

In another paper (van Poppel) was emphasized that the RPE is certainly an option for prostate cancer stage cT3 (clinically detected capsule breakdown). Because they would offer patients a great chance of recovery, where it turns out after the surgery that the tumor was still localized (pT2) in whom clinically ie too high a stage had been diagnosed (engl. over staging). The same is true for some patients with tumors with low capsule exceeded (including low seminal vesicle invasion). In capsule rupture (pT3) and lymph node involvement (pN1), it would indeed frequent progression of the disease, so that a hormone or radiation therapy will require. However, this was often only after several years of case and then finally still possible.

A study of 1649 patients (Prlic), the RPE were treated for lymph node dissection and had received adjuvant or delayed hormonal or radiation therapy depending on the findings, revealed the following 5-year rates for overall survival, cancer-specific survival (proportion of not at the tumor deceased) and survival without PSA -rebound: For seminal vesicle invasion 85%, 86% and 50% for lymph node involvement 78%, 80% and 48%. Affected by such an attack were about 20% of patients, which therefore still had good chances of survival. However, there came over the years with many of PSA rise again.

That such a treatment with RPE, lymphadenectomy and, where appropriate adjuvant or later hormone or radiation therapy even in patients with very high risk of progression of the disease provides a good long-term tumor control, also showed another study (Spahn). However, they included only 89 patients with a tumor in stage cT3 or cT4, a PSA level of more than 20ng/ml and a Gleason score in the biopsy of 8-10. In about half there was a lymph node involvement (pN1), while the other does not (pN0). The 5-year survival rates for the total, the cancer-specific survival and survival without PSA rebound were as follows: In pN0 91%, 91% and 52%, pN1 in 82%, 74% and 59%. The infestation of the lymph nodes were then surprisingly has no significant impact on overall survival.

Another study (Bastian) addressed the question of whether an RPE should be discontinued, if it turns out an infestation of the lymph nodes in frozen section (histological examination during surgery): The cancer-specific 5-year survival rate (in brackets the 10-year value) was at 456 patients broken RPE 70% (40%) in 957 patients with complete RPE but 90% (95%). The RPE should therefore be performed even with positive lymph nodes to the end.