Primary treatment of the prostate improves local palliation in men who ultimately develop castrate-resistant prostate cancer


Correspondence: Manish I. Patel, Urological Cancer Outcomes Centre, Sydney Medical School, University of Sydney, Australia.




  • 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).

Patients and 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).


  • 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%).


  • 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.