[Influence of local treatment on the biology of advanced prostate cancer : Treatment of the primary tumor may delay hormone resistance of metastases].

Background: In metastatic prostate cancer, a trend towards longer survival has been observed over the last 15 years. Beyond progress due to new drugs, retrospective data also suggest a positive influence of a prior treatment of the primary tumor.

Objectives: Can treatment of the primary tumor improve the prognosis of patients later developing metastases, and if yes, what are the underlying mechanisms.

Materials And Methods: In addition to a critical review and discussion of the literature, we analyzed the long-term outcomes of 115 patients with T4 prostate cancer, who had undergone radical prostatectomy after inductive hormonal therapy at our institution.

Results: Of the 115 patients, 84 developed prostate-specific antigen (PSA) recurrence during the further course of disease and must therefore be regarded as uncured. Tumor-specific and overall survival of these 84 patients after 150 months were 61 and 44%, respectively. A total of 47 patients were alive after a median follow-up time of 95 months, of whom 31 were still receiving standard hormonal therapy. Only 13 had developed resistance towards their primary hormonal therapy and, hence, received tertiary hormonal therapy. Again, long-term responses were found in some of these patients.

Conclusions: Primary tumor resection, at least under the circumstances described here, seems to delay the development of castration resistance in metastatic prostate cancer or to completely prevent it in individual cases.