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A systematic review of imaging-guided metastasis-directed therapy for oligorecurrent prostate cancer: revolution or
Simone Albisinni1, Julien Van Damme2, Fouad Aoun3,4
1Department of Urology, Hôpital Erasme, University Clinics of Brussels, Free University of Brussels, Brussels, Belgium - simone.albisinni@erasme.ulb.ac.be.
Introduction:
Metastasis directed therapy (MDT) is increasingly being implemented in recurring prostate cancer (PCa), although its role in PCa management has yet been fully defined. Aim of the current systematic review is to analyze current knowledge of MDT in the setting of recurrent PCa and highlight future trials which will continue to shed a light on a controversial aspect of current PCa management.
Evidence Acquisition:
The National Library of Medicine Database was searched for relevant articles published between January 2014 and August 2019. A wide search was performed including the combination of following words: ([metastasis AND directed AND therapy] AND prostate AND cancer). The selection procedure followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles.
Evidence Synthesis:
Biologic studies support the use of MDT in oligometastatic PCa. Modern imaging techniques as PSMA PET/CT, Fuciclovine PET/CT and whole-body MRI are fundamental to implement such an approach given the high diagnostic yield at low PSA values. The majority of data available on MDT concerns retrospective trials, although three prospective randomized trials (STOMP, ORIOLE and POPSTAR) have assessed the safety and feasibility of MDT. Overall, it appears that MDT delays significantly PCa progression and time to systemic therapy.
Conclusions:
MDT is highly appealing given its potential to delay disease progression and adverse events of systemic therapy. Nonetheless, data remains immature to recommend MDT on a large scale and the selection criteria for patients have yet been defined. Today, MDT should be administered within a clinical trial and results of future research are eagerly awaited.
Insights
Metastasis directed therapy (MDT) shows promise in delaying prostate cancer (PCa) progression and the need for systemic therapy. However, more research is needed to define patient selection criteria for widespread MDT use.
Area of Science:
- Oncology
- Urology
- Radiology
Background:
- Metastasis directed therapy (MDT) is gaining traction for recurrent prostate cancer (PCa).
- Its precise role in PCa management remains under investigation.
- This systematic review examines current knowledge and future directions for MDT in recurrent PCa.
Purpose of the Study:
- To systematically review current knowledge on metastasis directed therapy (MDT) in recurrent prostate cancer (PCa).
- To identify future clinical trials addressing the role of MDT in PCa management.
Main Methods:
- Systematic literature search of the National Library of Medicine Database (January 2014 - August 2019).
- Keywords: metastasis directed therapy, prostate cancer.
- Study selection followed PRISMA principles.
Main Results:
- Biologic studies support MDT for oligometastatic PCa.
- Advanced imaging (PSMA PET/CT, Fuciclovine PET/CT, whole-body MRI) is crucial for MDT implementation.
- Three prospective trials (STOMP, ORIOLE, POPSTAR) assessed MDT safety and feasibility.
- MDT significantly delays PCa progression and time to systemic therapy.
Conclusions:
- MDT is appealing for potentially delaying disease progression and systemic therapy adverse events.
- Current data is insufficient for large-scale MDT recommendation; patient selection criteria are undefined.
- MDT should currently be administered within clinical trials; further research is anticipated.
