Multivisceral surgery in patients with locally advanced castration-naïve and castration-resistant, symptomatic prostate cancer.

Abstract

176 Background: Local complications due to infiltration and compression of adjacent organs represent significant complications of locally advanced castration sensitive (CSPC) and castration resistant PCA (CRPC) despite the use of life prolonging agents. Methods: 139 patients with locally advanced CSPC/CRPC underwent palliative pelvic surgery: radical cystoprostatectomy in n=105 (75.5%), radical prostatectomy with continent vesicostomy in n=9 (6.5%) and anterior plus posterior exenteration in n=25 (17.6%). All patients underwent local staging via MRI of the small pelvis, cystoscopy and rectoscopy. Systemic staging was done with CT scans of the chest, abdomen, pelvis and bone scans. Perioperative complications were assessed according to Clavien-Dindo classification and symptom-free (SFS), cancer specific survival (CSS) were evaluated using the Kaplan-Meir method. Results: Indications for surgery were lower or upper urinary tract obstruction in 75 (54%) and 55 (39%), resp., hematuria and blood transfusions in 31 (22%), rectal infiltration with/without obstructive ileus in 23 (17%), refractory pelvic pain in 17 (12%). 96 (69%) pts had a combination of various symptoms. Clavien-Dindo grade 2, 3 and 4 complications developed in 32 (23%), 12 (8.6%) and 8 (5.7%), respectively. After a median follow-up of 42.5 (3 – 123) months, the SFS at 1 and 3 years was 90.3% and 66.9%. The median SFS was 27.9 months. CSS at 1 and 3 years was 92.2% and 43.7%, respectively. 78.6% of the patients were symptom-free during their remaining lifetime. Conclusions: Multivisceral prostate surgery is a technically feasible approach in well-selected patients resulting in symptom relief of > 90% of patients which covered almost 80% of the remaining life-time. Adequate preoperative imaging studies, endoscopic evaluation and extensive surgical experience is mandatory to achieving a benefit for the individual patient with improvement of quality of life.