[Palliative surgery for metastatic prostate cancer]

Area of Science:

• Uro-oncology
• Medical oncology
• Surgical oncology

Context:

• Standard treatments for metastatic hormone-sensitive prostate cancer (mHSPC) include androgen deprivation therapy with novel hormonal agents, docetaxel, or combinations.
• While effective, these therapies eventually lead to castration-resistant prostate cancer (CRPC) in most patients within 2.5-4 years.
• Improved survival due to advanced treatments results in a growing incidence of symptomatic local prostate cancer progression (50-65% of patients).

Purpose:

• To highlight the increasing importance of surgical management options for symptomatic local progression in prostate cancer.
• To inform uro-oncologists about palliative surgical interventions for lower and upper urinary tract complications.
• To provide an overview of surgical techniques for managing complications arising from advanced prostate cancer treatments.

Summary:

• Advanced prostate cancer treatments prolong survival but increase symptomatic local progression. Palliative surgeries like transurethral resection of the prostate (TURP), cystectomy, and pelvic exenteration address lower urinary tract issues.
• Upper urinary tract obstruction can be managed with urinary diversions (endoluminal or percutaneous), ureteral reimplantation, or ileal ureter replacement.
• Surgical interventions are crucial for managing complications such as hematuria, obstruction, retention, and fistulas, improving quality of life in advanced prostate cancer.

Impact:

• Surgical management of local progression symptoms is becoming essential for improving patient outcomes and quality of life.
• Awareness of surgical options empowers uro-oncologists to effectively manage complications associated with prolonged survival in prostate cancer.
• This focus on palliative surgery addresses a critical unmet need in the evolving landscape of advanced prostate cancer care.