Expanding Role of Surgery in Metastatic Prostate Cancer

 At the American Urological Association

opens in a new tab or window annual meeting, several studies explored the potential role of surgery in managing metastatic prostate cancer.

In this exclusive MedPage Today video, Jeremy Slawin, MD, of the Baylor College of Medicine in Houston, highlighted these developments, and discussed how emerging findings might redefine the surgical approach in this traditionally non-surgical disease space.

Following is a transcript of his remarks:

One of the studies that related to prostate cancer that has really interested me as a urologist involves the surgical care of metastatic prostate cancer. So the standard treatments for metastatic prostate cancer for decades have been treatments that go to the whole body, things like androgen deprivation therapy [ADT] and other medications that can treat multiple sites of disease. But there are some ongoing trials looking at, is there a role for surgery in this setting as well?

And I think probably the most well-known one is called the SWOG 1802 trialopens in a new tab or window, or the Southwest Oncology Group number 1802 trial. And what they're looking at is for patients who have metastatic prostate cancer, is getting those kinds of standard treatments alone, or getting one of those standard treatments with the addition of surgery to remove the prostate where the metastatic disease is kind of stemming from, is adding surgery beneficial to those patients?

They're also looking to see if radiation therapy is going to be helpful. But essentially the crux of this study is the standard systemic therapy alone versus systemic therapy with additional treatments to the prostate going to be equivalent or potentially better with treating the prostate. And as urologists, we are the surgical kind of providers, really, who care for prostate cancer. And this is a great interest, I think, to a lot of urologists to see if there's a role for us in this disease space when previously it's really been solely managed by medical oncologists.

Again, as urologists, we're wondering, is there a role for surgery in these patients who have metastatic prostate cancer? So at our VA hospital, we've been working on the STARPORT trialopens in a new tab or window, which is looking at if you give treatment to the metastatic lesion, is that helpful?

Again, the standard-of-care treatment for metastatic prostate cancer has been just ADT and these systemic agents alone, and we're looking at randomizing patients to that standard regimen versus getting that, and in addition, getting treatment to the metastatic lesion in question. So if you have a lymph node that has spread from the prostate, does surgically removing that lymph node or providing radiation therapy to that lymph node provide some benefit?

That trial is also ongoing. We don't have the results of that just yet, but I think, again, urologists are very intrigued at the potential roles for surgical management of a disease that historically has never really involved any surgical management.

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