Treatment Options in Oligometastatic Disease in Prostate Cancer: Thinking Outside the Box

Area of Science:

• Oncology
• Urology
• Medical Imaging

Background:

• Metastatic prostate cancer often presents with limited disease volume due to indolent progression, sensitive PSA testing, and advanced PET imaging.
• Oligometastatic disease, defined as up to five metastatic lesions, warrants consideration for specialized treatment approaches.

Purpose of the Study:

• To review the current understanding and emerging strategies for managing limited-volume metastatic prostate cancer.
• To highlight the role of systemic therapy and metastasis-directed therapies (MDT) in oligometastatic prostate cancer.

Main Methods:

• Review of recent studies and clinical evidence regarding treatment approaches for metastatic prostate cancer.
• Focus on the integration of androgen deprivation therapy (ADT), systemic agents, and local MDT (radiation, surgery).

Main Results:

• Systemic therapy is the cornerstone, with potential benefits from adding a second agent to ADT.
• Integration of systemic therapy with local MDT to the prostate and metastatic sites demonstrates significant benefits.
• MDT can be utilized to delay systemic therapy initiation in select patients.

Conclusions:

• An oligometastatic treatment approach is suitable for prostate cancer patients with up to five metastatic lesions.
• Combining systemic therapy with MDT offers significant advantages.
• For isolated regional nodal recurrences, whole pelvic radiotherapy or extensive lymphadenectomy with ADT is recommended.