S.V. Golovko, A.S. Golovko

Modern approaches to local treatment of metastatic prostate cancer (literature review)

The potential oncological benefit of modern technological, laboratorial and imaging studies significantly improved disease-free survival rates in patients suffering from prostate cancer (PCa). Systematic reviews carried out in men with metastatic prostate cancer (mPCa) identify plenty of studies, especially dedicated to local treatment options. Unfortunately, young and fit patients with mPCa at diagnosis present unexpected resistance towards proposed treatment. Oncological outcomes demonstrate high rate of cancer-specific and overall mortality with precursory invasion of adjacent structures and impaired quality of life in patients.

Current literature review was carried out using mainly PubMed and SciELO database to identify and analyze advances of local treatment of mPCa. The most relevant articles included studies performed from March 2005 to November 2020.

According to the last brief reviews, main indication for providing primary treatment of PCa includes nonmetastatic PCa. Additionaly, it may be performed as palliative treatment for mPCa to minimize local invasion, prevent arising of new metastasis and provide better biological answer of chemotherapy and hormonal treatment. Recent data suggests that local treatment and overall survival turned out to be more effective in patients under 70 years. Thus, independent negative prognostic factors mentioned in patients with mPCa are age above 70 years, cT4 stage or high-grade disease, PSA і 20 ng/ml, and pelvic lymphadenopathies. While comparing patients who underwent local treatment with those one who did not, the presence of these 3 or more CSS and OS factors conditions remains the same. Metastasis degree and location number can also influence outcome. Furthermore, visceral metastases lead to worse prognosis.

Exploring new treatment options for mPCa awoke interest in scientists in recent years. Radical prostatectomy and target radiation therapy remain the most effective in achieving local disease control and, thus, control of systemic disease. There is growing evidence supporting local treatment in cases of metastatic prostate cancer at diagnosis in the context of a multimodal approach. However, its oncological effect requires prospective studies with well-defined patient selection criteria. Prospective multicentric studies might sustain the existing data and define the main indications for primary treatment in mPCa.