What is Prostate Cancer?
​​Prostate cancer is the second most common cancer in men and is usually diagnosed early. However, some patients develop aggressive or recurrent disease that can spread to nearby tissues. Peritoneal metastases—cancer spread to the lining of the abdomen—are extremely rare in prostate cancer, with only a few cases reported.
While there is abundant information on more conventional treatments for Prostate Cancer, our focus here will be on the rationale and available data supporting the use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in these specific cases. It is important to emphasize that evidence regarding the benefit of CRS/HIPEC for Prostate Cancer remains limited. Nevertheless, reports suggest potential benefits for certain patients facing Prostate Cancer with rare indications for CRS/HIPEC.
Prostate cancer is the second most common cancer in men worldwide.[see References: 1] It is typically diagnosed at an early stage (>70% of cases) and often remain localized, contributing to a 5-year survival rate of >98%.[2, 3] However, some patients have aggressive forms of the disease, characterized by a high Gleason score, and may have tumors spread from their origin in the prostate (metastatic disease) or experience recurrence after initial treatment. The most common sites of recurrence include the prostate bed and surrounding tissue, bone, and lymph nodes.[4] Peritoneal metastases (prostate tumors that have developed secondary malignant growths in the lining of the abdomen), however, are extremely rare, with only a few cases reported in the literature.[5-8] Clinicians suspect that these rare metastases may result from tumor seeding following the surgical removal of the prostate (also called a prostatectomy which is performed either robotic or laparoscopic, for early stage disease or from an aggressive subtype (Gleason ≥ 6), although the exact risk factors remain unclear.[9, 10]
Prostate cancer treatment options include active surveillance, surgery (prostate removal), radiation, hormone therapy, and chemotherapy, among others. Most patients respond well to these treatments and can be managed effectively. However, some patients present with metastatic disease at diagnosis (those with cancer that has spread from where it started to another part of the body). Other patients may develop metastases after receiving definitive treatment, or the treatment plan that has been chosen by their doctor as the best one for a patient after all other choices have been considered. The management of metastatic prostate cancer depends on individual patient factors, such as the extent of disease and the risk of aggressive behavior. Treatment typically involves a combination of androgen deprivation therapy, other forms of hormone therapy, and/or docetaxel-based chemotherapy.[11]
There are currently no established guidelines for managing peritoneal metastases from prostate cancer and it is generally associated with poor survival, typically <6 months.[12] The few studies that address peritoneal metastases, primarily document the occurrence of this rare metastatic site rather than providing detailed information on outcomes or treatment strategies.[13-15] Reported cases have been treated with chemotherapy, hormone therapy, or palliative measures such as repeated paracentesis to remove ascites, a procedure in which a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid. Survival times have varied widely, ranging from 3-6 weeks with palliative care to 4-25 months with chemotherapy and/or hormone therapy.[12], [16-22] One of the larger studies, which reported 6 patients with peritoneal metastases from prostate cancer treated with docetaxel-based chemotherapy, reported a median overall survival of 24.5 months.[9] While hormonal and chemotherapy treatments seem to decrease PSA (tumor marker) levels, they have shown limited impact on tumor burden or symptom relief.[23-26] Factors such as Gleason score, extent of disease, and previous treatment response have been suggested to influence outcomes, but the lack of comprehensive data makes it difficult to draw definitive conclusions.
The evidence supporting the use of surgery to manage peritoneal metastases from prostate cancer is extremely scarce, with only 1 case report available in the literature.[27] This case involved a patient with a BRCA2 mutation, which is a genetic mutation commonly associated with ovarian cancer, and peritoneal carcinomatosis from prostate cancer. The patient was treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), resulting in a prolonged treatment response and remaining disease-free 30 months after surgery. The authors suggested that managing this case in a manner similar to ovarian cancer was reasonable, given the patient’s comparable presentation and BRCA2 mutation profile. While the patient achieved long-term benefits, this surgical approach is highly experimental and should only be considered in select patients at specialized centers with experience in this treatment.
Finding Specialized Care
Finding a care provider who is knowledgeable with colorectal cancer and how to treat it is critically important. To search for providers who specialize in performing CRS/HIPEC and providers who specialize in colorectal cancer, navigate to our Find a Specialist page.​​
Please note: Our goal is to provide information to help you find a doctor closest to your home that can provide the best quality of care for your diagnosis or your anticipated CRS/HIPEC procedure. The Abdominal Cancers Alliance does not endorse any care provider or medical center over another.
Clinical Trials
There are many actively recruiting clinical trials for prostate cancer registered online. A full list of all active clinical trials and their current recruitment status can be found on www.ClinicalTrials.gov. There are currently no clinical trials for HIPEC in prostate cancer, probably due to the rarity of the situation. Your oncologists (medical, surgical, and radiation) can also help you review clinical trial options and recommendations.
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Recurrent prostate carcinoma presenting as omental large cell carcinoma with neuroendocrine differentiation and resulting in bowel obstruction. Arch Pathol Lab Med. 2000 Jul;124(7):1074-6. doi: 10.5858/2000-124-1074-RPCPAO. PMID: 10888786. 23. Couture F, Chin J, Chong J, Tanguay S. Isolated peritoneal carcinomatosis from metastatic castration-resistant prostate cancer and associated biliary obstruction: A case report. Urol Case Rep. 2018 Aug 12;21:10-11. doi: 10.1016/j.eucr.2018.08.007. PMID: 30128294; PMCID: PMC6097279. 24. van Golen LW, Seijkens TTP, de Feijter JM, Vogel W. Peritoneal Metastases From Prostate Carcinoma Treated With 177 Lu-PSMA-I&T. Clin Nucl Med. 2023 May 1;48(5):422-425. doi: 10.1097/RLU.0000000000004577. Epub 2023 Jan 31. PMID: 36716524. 25. Jang HR, Lee K, Lim KH. Isolated Peritoneal Metastasis of Prostate Cancer Presenting with Massive Ascites: A Case Report. Curr Oncol. 2022 Jun 21;29(7):4423-4427. doi: 10.3390/curroncol29070351. 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