Chemotherapy for oligometastatic prostate cancer

To analyze recent trials of upfront chemotherapy to determine how this paradigm can be applied to oligometastatic prostate cancer patients.

Upfront chemotherapy prolongs survival in metastatic prostate cancer, according to the ChemoHormonal Therapy versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer and STAMPEDE docetaxel trials. However, the benefit is driven by the high volume subset and may not apply to low-volume/oligometastatic patients.

Oligometastatic patients may not all share the same biology. Advanced imaging techniques may help to more accurately identify truly oligometastatic patients. Molecular markers will be necessary to distinguish oligometastatic patients who fare well enough with androgen deprivation therapy alone as opposed to those for whom upfront chemotherapy may be beneficial. Emerging molecular markers of docetaxel sensitivity, such as loss of lysine-specific demethylase 5d, warrant prospective validation with one goal of identifying oligometastatic patients with greatest likelihood of benefit from this strategy.