Can Radical Prostatectomy Benefit Patients Despite the Presence of Regional Metastases?

摘要

Ten years ago, based on data from a retrospective, nonrandomized study, researchers from the Mayo Clinic concluded that patients with lymph node-positive prostate cancer (PCa) treated by radical prostatectomy (RP) and androgen deprivation therapy (ADT) had a significantly improved probability of overall survival (OS) when compared to a carefully matched group of patients with similar age, T stage, number of positive nodes, and preoperative prostate-specific antigen (PSA; if available) treated with ADT only. The 10-yr OS probability was approximately 65% for patients treated with RP and ADT compared with only approximately 30% in the matched patients receiving ADT only [1]. Coen et al reported that patients with negative biopsies of the prostate after radiation therapy had a significantly better outcome than patients with positive biopsies, a sign of local treatment failure [2]. In the patients with apparent local control of the disease, the incidence of metastasis decreased significantly after a few years, whereas it progressively increased in the group of patients without local control, suggesting that the primary tumor continues to shed PCa cells into the blood circulation.