Metastatic prostate cancer, where cancer cells from the prostate gland have spread to other parts of the body, is a complex and challenging condition to treat. While surgery plays a limited role in the treatment of metastatic prostate cancer, it is generally not considered a curative option at this advanced stage of the disease. Instead, other systemic treatment modalities are typically used as the primary approach to manage the cancer and its symptoms.
Surgery for metastatic prostate cancer is rarely performed with the intent to cure the disease. Instead, surgical interventions may be considered in certain situations to address specific complications or symptoms caused by the spread of cancer to other organs or tissues. For example, surgical procedures such as transurethral resection of the prostate (TURP) may be performed to relieve urinary obstruction or other urinary symptoms caused by metastatic prostate cancer. In some cases, surgery to stabilize or prevent fractures due to bone metastases may also be considered.
The primary treatment modalities for metastatic prostate cancer include systemic therapies such as hormone therapy, chemotherapy, targeted therapy, immunotherapy, and radionuclide therapy. Hormone therapy, also known as androgen deprivation therapy, is a common initial treatment for metastatic prostate cancer, aimed at lowering the levels of male hormones (androgens) in the body to slow the growth of cancer cells. Chemotherapy may be used in cases where the cancer has become resistant to hormone therapy or has spread extensively. Targeted therapies and immunotherapies are newer treatment approaches that target specific molecular pathways or the immune system to fight cancer cells.
Oligometastatic prostate cancer (omPCa) is a new classification characterized by small numbers of metastatic cells and specific locations. Accurate staging, as provided by prostate-specific membrane antigen-positron emission tomography, is very important to reveal the true face of oligometastatic disease. Drawing on the results of prospective studies using traditional and/or modern staging methods, the treatment landscape for omPCa has evolved rapidly in recent years. Several treatment-related questions involving the concept of precision hitting are under development. For example, beyond systemic therapy, cohort studies have found that cytoreductive radical prostatectomy (CRP) may benefit survival in select patients with omPCa. Importantly, when tumor disease has progressed due to resistance to systemic treatments, CRP has been shown to permanently improve long-term local symptoms.
While surgery is not typically a primary treatment for metastatic prostate cancer, it may play a role in the overall management of the disease as part of a multidisciplinary approach. The decision to perform surgery in cases of metastatic prostate cancer is made on a case-by-case basis, taking into consideration factors such as the extent of the cancer, the overall health and preferences of the patient, and the goals of treatment (e.g., symptom relief, improving quality of life).
In conclusion, while surgery is not a curative option for metastatic prostate cancer, it may be considered in specific situations to address complications or symptoms associated with the disease. Also oligometastatic prostate cancer can be treated by cytoreductive radical prostatectomy. The primary treatment modalities for metastatic prostate cancer include systemic therapies.