Universität zu Köln

Heidenreich, Axel, Porres, Daniel and Pfister, David (2015). The Role of Palliative Surgery in Castration-Resistant Prostate Cancer. Oncol. Res. Treat., 38 (12). S. 670 - 677. BASEL: KARGER. ISSN 2296-5262

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Abstract

Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone (LHRH) analogues or antagonists represents the treatment of choice in men with metastatic prostate cancer (PCA). Depending on the serum concentration of the prostate-specific antigen (PSA) nadir, the survival might vary between 11 and 78 months. In castration-resistant PCA (CRPC), all new medical treatment options can induce complete and partial remissions in metastatic foci, but they have no profound effect on the prostate itself, as has been shown recently. About one-third of all patients without local treatment of the primary will develop significant complications of the lower and upper urinary tract due to local progression of the PCA. In men with CRPC and lower urinary tract symptoms, palliative transurethral resection of the prostate (TURP) can be performed with a 60-70% success rate. Infiltration of the pelvic floor, the bladder neck and trigone, and the external urethral sphincter can make palliative radical surgery necessary. Bladder neck closure with continent vesicostomy, radical cystoprostatectomy with an incontinent urinary diversion, and anterior and posterior exenteration are individual therapeutic options in men with a good performance status and a considerable life expectancy. Symptomatic involvement of the upper urinary tract can be managed by the placement of endoluminal stents or a percutaneous nephrostomy in men with poor performance. In men with a good response to ADT and a good performance status, reconstructive ureteral surgery might be considered and the options of ureteral reimplantation, ureter ileal replacement, and a subcutaneous pyelovesical bypass have to be discussed. The indication to perform one of the above-mentioned surgical approaches needs to be discussed in a multidisciplinary tumor board. (C) 2015 S. Karger GmbH, Freiburg

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Porres, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-385456
DOI:	10.1159/000442268
Journal or Publication Title:	Oncol. Res. Treat.
Volume:	38
Number:	12
Page Range:	S. 670 - 677
Date:	2015
Publisher:	KARGER
Place of Publication:	BASEL
ISSN:	2296-5262
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MALIGNANT URETERAL OBSTRUCTION; BLADDER NECK CLOSURE; PERCUTANEOUS NEPHROSTOMY; TRANSURETHRAL RESECTION; RADICAL PROSTATECTOMY; ANDROGEN DEPRIVATION; MANAGEMENT; DIVERSION; SURVIVAL; DISEASE Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38545