Biochemical remission after resection of prostate cancer lung metastasis

doi:10.1016/j.urology.2003.10.069

Urology

Volume 63, Issue 3, March 2004, Pages 584-585

https://doi.org/10.1016/j.urology.2003.10.069 Get rights and content

Abstract

Once metastatic, prostate cancer was regarded as a systemic disease that is not amenable to surgical therapy. We present a case of a solitary pulmonary recurrence of prostate cancer after radical prostatectomy that was resected, resulting in 12 years of biochemical remission without additional therapy.

Section snippets

Case report

A 68-year-old man with a serum prostate-specific antigen (PSA) level of 6.7 ng/mL underwent radical prostatectomy with pelvic lymph node dissection for clinical Stage T2a, Gleason grade 4+3 prostate cancer. The specimen had a 4-cm Gleason grade 4+5 tumor involving the right lobe, no evidence of capsular invasion, negative surgical margins, negative seminal vesicles, and negative lymph nodes. Microvascular invasion of the tumor was present. An additional focus of Gleason grade 2+3 tumor was

Comment

Long-term, cancer-free survival has been reported after resection of a solitary pulmonary metastasis in several malignancies, including renal cell carcinoma, colon and breast cancers, and sarcomas.3, 4, 5, 6 Incidental discovery of metastatic prostate cancer during the resection of a solitary lung lesion has been reported,7, 8, 9 although without documented long-term follow-up. We are the first to report apparent curative resection of a prostate carcinoma metastatic to the lung. This

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Opérer les métastases pulmonaires permet des survies prolongées et s’intègre maintenant aux traitements multimodaux. Notre propos a été de revoir l’évolution de cette chirurgie avec le temps.
Patients de 1983 à 2006 revus rétrospectivement : âge, sexe, cancer primitif, exérèse, anatomopathologie des métastases, chimiothérapie périopératoire.
Deux cent vingt-cinq hommes et 145 femmes ont subi 472 opérations : 448 complètes (221 résections atypiques, 47 segmentectomies, 148 lobectomies, 32 pneumonectomies) et 24 incomplètes. La majorité des métastases étaient colorectales (n = 129), rénales (n = 73) et sarcomateuses (n = 34), les taux de survie de 38,5 % et 24,3 % à cinq et dix ans. Étaient de mauvais pronostic l’exérèse incomplète ou importante (lobe ou poumon), la taille, l’envahissement ganglionnaire, des micro-emboles intravasculaires et non l’intervalle de temps, le siège et le nombre des métastases. Le pronostic était meilleur depuis 1998 et après chimiothérapie périopératoire (n = 77). Le taux de survie des métastases uniques, candidates à une radiofréquence, était de 48 % à cinq ans.
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Citation Excerpt :
Interestingly an inordinate number of patients had small cell carcinoma or transitional cell carcinoma of the prostate. Chao et al recently reported on a patient who underwent metastasectomy for a single lung lesion that occurred after prostatectomy.48 Subsequently the patient achieved 12 years of biochemical remission without any other therapy.
In the past patients with metastatic cancer were considered incurable and they were not candidates for surgical management of metastases. However, experience with testicular cancer has shown that metastasectomy can often be the final, critical step in achieving disease-free status. We summarized the most current data on metastasectomy for advanced urological malignancies.
We performed an extensive review of the literature from 1990 to the present using MEDLINE. Only original reports were included with an emphasis on specific malignancies and specific sites of metastasis.
There is increasing evidence that patients with metastatic renal cell carcinoma and bladder carcinoma can be cured by surgical resection of metastases, usually combined with systemic therapy. The ideal patient has responded to systemic therapy and has few metastatic sites.
Metastasectomy should frequently be done in patients with advanced testicular cancer and it should increasingly be considered in patients with metastatic renal cell carcinoma or bladder carcinoma. This technique may be used for cure and palliation. Specific patient factors determine the likelihood and degree of potential benefit.
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Case reportBiochemical remission after resection of prostate cancer lung metastasis

Abstract

Section snippets

Case report

Comment

Hum Pathol

Clin Radiol

J Urol

J Urol

J Urol

Urol Clin North Am

Case report
Biochemical remission after resection of prostate cancer lung metastasis