Surgical removal of metastases reasonable?

Surgical removal of metastases reasonable?

Individual prostate cancer metastases can be operated in selected cases, to the benefit but there is no meaningful studies, concludes a survey that was presented at the German Association of Urology congress in 2012.

The surgical removal of metastases, which were already present in the initial treatment of a malignant tumor or occur later, is standard in many tumors and improves the patient's prognosis. In prostate cancer, however, the current guidelines provide that such an approach not as a treatment option before, although there is always more to reports.

Removal of lymph nodes

Under a salvage lymphadenectomy (SLA, literally: Rescue lymph node dissection) is defined as the operative removal of individual lymph node metastases after initial treatment, which aimed at healing, so after radical prostatectomy or radiation therapy . Befallen are mostly regional lymph nodes (in the vicinity of the prostate) or lymph nodes behind the peritoneum. You can, for example by means of PET / CT track, the result of which, however, depends on many factors such as the height of the PSA value (see also the note below).

For the effect of the SLA, there are few studies. After the largest in the PSA level fell slightly more than half of the patients within 40 days to less than 0.2 ng / ml. However, about one-third of them had received an additional hormone therapy, which has probably contributed to the effect. In patients with such a drop in PSA, but without further hormonal latter could be postponed at least until a new PSA increase. The Influence of SLA on the survival time, there are no data.

Removing other metastases

For this there are no studies, only individual case reports. These relate to the operation of individual organ metastases, usually in the lungs. The follow-up periods were very different, as the additional treatment (such as hormone-therapy and chemotherapy). Therefore, to judge not, what impact has the sole operation of the metastases, even if the additional treatments be more effective. Statements about anyway would not representative because there are no reports on the removal of single bone metastasis. Because these develop in the vast majority of cases, and one can not exclude that the forecast already alone depends on whether form metastases in bone or "only" in other organs.

Conclusion of the author

Because of the sparse data, neither the salvage lymphadenectomy nor the operative removal of other metastases may be recommended. Both are a way to possibly postpone a hormone or chemotherapy, with their benefits, however, can not assess in selected cases. Is therefore necessary to decide in each case together with the patient must be informed of the experimental nature of the methods of their use.

Note

After the German guideline for the investigation of a relapse (recurrence) of the tumor after radical prostatectomy: With a PSA value below 1ng/ml no PET / CT for the assessment of tumor extension is to take place. For a PSA level over 1ng/ml can be carried out such an investigation, however, when a surgical removal or irradiation targeted lymph nodes in the "salvation of an individual experiment" framework is sought.