title: Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives.
abstract: Multimodal treatment for men with locally advanced prostate cancer (PCa) using neoadjuvant/adjuvant systemic therapy, surgery, and radiation therapy is being increasingly explored. There is also interest in the oncologic benefit of treating the primary tumor in the setting of metastatic PCa (mPCa).
  
  
  
  To perform a review of the literature regarding the treatment of the primary tumor in the setting of mPCa.
  
  
  
  Medline, PubMed, and Scopus electronic databases were queried for English language articles from January 1990 to September 2014. Prospective and retrospective studies were included.
  
  
  
  There is no published randomized controlled trial (RCT) comparing local therapy and systemic therapy to systemic therapy alone in the treatment of mPCa. Prospective studies of men with locally advanced PCa and retrospective studies of occult node-positive PCa have consistently shown the addition of local therapy to a multimodal treatment regimen improves outcomes. Molecular and genomic evidence further suggests the primary tumor may have an active role in mPCa.
  
  
  
  Treatment of the primary tumor in mPCa is being increasingly explored. While preclinical, translational, and retrospective evidence supports local therapy in advanced disease, further prospective studies are under way to evaluate this multimodal approach and identify the patients most likely to benefit from the inclusion of local therapy in the setting of metastatic disease.
  
  
  
  In this review we explored preclinical and clinical evidence for treatment of the primary tumor in metastatic prostate cancer (mPCa). We found evidence to support clinical trials investigating mPCa therapy that includes local treatment of the primary tumor. Currently, treating the primary tumor in mPCa is controversial and lacks high-level evidence sufficient for routine recommendation.
authors.affiliation: Department of Urology, The George Washington University, Washington, DC, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Bayne
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.affiliation: Departments of Urology and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Gleave
authors.affiliation: Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Wiklund
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: bfchapin@mdanderson.org.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Chapin
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D011878:Radiotherapy; D018570:Risk Assessment
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Neoplasm metastasis; Prostatectomy; Prostatic neoplasms; Survival