Newly Diagnosed Oligometastatic Prostate Cancer: Current Controversies and Future Developments

Area of Science:

• Uro-oncology
• Medical imaging
• Radiation oncology

Background:

• Metastatic prostate cancer management, particularly oligometastatic disease, presents ongoing challenges.
• Conventional imaging (CT, bone scan) is used for staging, but molecular imaging is emerging.
• Androgen deprivation therapy (ADT) is a standard initial treatment.

Purpose of the Study:

• To present a case of newly diagnosed metastatic prostate cancer managed with a multimodal approach.
• To discuss key open questions regarding advanced imaging, local treatment, and metastasis-directed therapy in oligometastatic prostate cancer.

Main Methods:

• Patient diagnosed with cT3b, cN1, cM1b prostate cancer, ISUP grade 3.
• Underwent robot-assisted radical prostatectomy, pelvic lymph node dissection, and post-operative radiation therapy.
• Received androgen deprivation therapy (ADT) for a planned 36-month duration.

Main Results:

• Histopathological examination revealed ypT3b, pN1, R1 disease.
• Post-treatment, the patient's prostate-specific antigen (PSA) level became undetectable.
• The patient is nearing completion of ADT.

Conclusions:

• The optimal management of oligometastatic prostate cancer is complex and evolving.
• Further research is needed on the role of molecular imaging (e.g., PSMA PET/CT) in staging and treatment planning.
• The potential benefits of local therapies for the primary tumor and metastases require continued investigation.