title: Primary treatment of the prostate improves local palliation in men who ultimately develop castrate-resistant prostate cancer.
abstract: OBJECTIVE
  To determine whether local treatment of primary prostate cancer gives palliative benefit to men who later develop castrate-resistant prostate cancer (CRPC). Local treatments of primary prostate cancer are defined as radical retropubic prostatectomy (RRP) or external beam radiation therapy (EBRT).
  
  
  METHODS
  Patient records were reviewed in five different hospitals in Sydney, Australia, and 263 men with CRPC were identified. Eligible patients comprised men who had progressive disease during androgen deprivation therapy with castrate levels of testosterone. Clinical and pathological data were reviewed and evaluated using the chi-squared test and relative risk analysis to determine the relationship between previous local prostate treatment and complications secondary to local disease. The end-point was complications and morbidity attributed to cancer progression locally (i.e. from the prostate).
  
  
  RESULTS
  Primary treatment of the prostate by either RRP or EBRT significantly reduces the incidence of local complications compared to no primary treatment (32.6% vs 54.6%; P = 0.001). RRP showed a significantly lower level of local complications compared to EBRT (20.0% vs 46.7%; P = 0.007). The most common local complications were bladder outlet obstruction (35.0%) and ureteric obstruction (15.2%).
  
  
  CONCLUSIONS
  The present retrospective analysis supports the hypothesis that primary local prostatic treatment gives palliative benefit to men who later develop CRPC. RRP was associated with the lowest local complication rate experienced at the stage of metastatic disease.
authors.affiliation: Urological Cancer Outcomes Centre, Sydney Medical School, Sydney, NSW, Australia.
authors.forename: Andy C M
authors.initials: AC
authors.lastname: Won
authors.forename: Howard
authors.initials: H
authors.lastname: Gurney
authors.forename: Gavin
authors.initials: G
authors.lastname: Marx
authors.forename: Paul
authors.initials: P
authors.lastname: De Souza
authors.forename: Manish I
authors.initials: MI
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010166:Palliative Care; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D000726:Androgen Antagonists
keywords: castrate-resistant; external beam radiotherapy; morbidity; prostate cancer; prostatectomy