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Published on: March 6, 2018
Metastasis-directed therapy and prostate-targeted therapy in oligometastatic prostate cancer: a systematic review
Noriyoshi Miura1,2, Benjamin Pradere3,4,5, Keiichiro Mori3,6
1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria - norimiurajp@yahoo.co.jp.
Introduction:
The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa).
Evidence Acquisition:
We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality").
Evidence Synthesis:
After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear.
Conclusions:
We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
Insights
Metastasis-directed therapy (MDT) and prostate-targeted therapy (PTT) show feasibility for oligometastatic prostate cancer. However, high-quality evidence proving survival benefits from MDT and PTT is still lacking.
Area of Science:
- Oncology
- Urology
- Medical Physics
Background:
- Oligometastatic prostate cancer (PCa) presents a unique clinical challenge.
- The role of metastasis-directed therapy (MDT) and prostate-targeted therapy (PTT) in this setting is under investigation.
Purpose of the Study:
- To comprehensively review the existing evidence on the efficacy of MDT and PTT for oligometastatic PCa.
- To assess the impact of these therapies on patient survival outcomes.
Main Methods:
- Systematic literature search of PubMed, Web of Science, and Cochrane Library.
- Inclusion of studies based on specific keywords related to prostate cancer, oligometastasis, and treatment modalities.
- Evaluation of 81 selected studies, including randomized trials and retrospective analyses.
Main Results:
- Cytoreductive prostatectomy (cRP) showed feasibility but no significant overall survival benefit in prospective studies.
- Prostate-targeted radiotherapy demonstrated improved overall survival in men with a low metastatic burden in phase 3 trials.
- Stereotactic body radiation therapy improved androgen deprivation therapy-free survival, but overall survival benefits remain uncertain.
Conclusions:
- Current literature supports the feasibility of MDT and PTT for oligometastatic PCa, primarily based on retrospective data.
- There is a critical need for high-quality randomized controlled trials to confirm survival benefits.
- Ongoing prospective trials are expected to provide further insights into the role of MDT and PTT.
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