[Oligorecurrent prostate cancer: current management and perspectives]

Area of Science:

• Oncology
• Radiotherapy
• Nuclear Medicine

Background:

• Oligometastatic prostate cancer (PCa) is a growing research focus, driven by advanced PET imaging (e.g., ¹⁸F-choline, ⁶⁸Ga-PSMA).
• Metastasis-directed therapies (MDT), including Stereotactic Body Radiation Therapy (SBRT) and salvage lymph node dissection, have demonstrated efficacy in hormone-sensitive oligorecurrent PCa.
• Randomized trials indicate SBRT can delay androgen deprivation, reduce biochemical relapses, and improve overall survival.

Purpose of the Study:

• To review the current evidence and evolving role of metastasis-directed therapies (MDT) in oligometastatic prostate cancer (PCa).
• To highlight the application of MDT in both hormone-sensitive and castration-resistant PCa contexts.
• To discuss the basis for current clinical recommendations and ongoing research in MDT for PCa.

Main Methods:

• Review of retrospective studies and randomized phase 2 trials evaluating MDT for PCa.
• Analysis of data on PSA response, toxicity, treatment delay, and survival outcomes.
• Examination of guidelines from European Association of Urology (EAU) and American Society of Radiotherapy.

Main Results:

• Retrospective studies show PSA response and low toxicity with MDT for hormone-sensitive oligorecurrent PCa.
• Phase 2 trials demonstrate SBRT's ability to delay androgen deprivation, decrease biochemical relapses, and increase overall survival.
• Limited data exists for oligoprogressive metastatic castration-resistant PCa, but MDT is increasingly recommended over observation.

Conclusions:

• MDT, particularly SBRT, is a recommended approach for selected patients with oligometastatic prostate cancer.
• Evidence supports MDT's role in improving oncological outcomes and patient survival.
• Ongoing global studies aim to further define the precise role and optimal application of MDT in PCa management.