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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Emerging role for local therapy in oligometastatic prostate cancer
Nabila R Khondakar1, Jeunice Owens-Walton1, Michael Daneshvar1
1Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Abstract:
Oligometastatic prostate cancer is a subtype of metastatic disease that generally is defined by the presence of 5 or fewer metastatic lesions. Metastatic prostate cancer currently is treated with androgen deprivation therapy and additional systemic therapy, such as novel antiandrogen medications or chemotherapy. The management of metastatic prostate cancer is evolving, however, with the notion that some patients with low-burden metastatic disease may benefit from both local and systemic therapy. Local therapy of the prostate in the setting of oligometastatic prostate cancer is a new concept. Evidence from retrospective studies suggests that cytoreductive therapy, including radical prostatectomy, can improve overall survival in these patients. Ongoing randomized trials are comparing cytoreductive therapy with standard-of-care treatment options. Local therapy in the form of radiation has also been investigated in phase 2 randomized trials. In this review, we discuss the biological and clinical rationales for local therapy, review the current evidence for local therapy, and compare the clinical designs of various ongoing trials.
Insights
Oligometastatic prostate cancer, defined by few metastases, may benefit from local prostate treatments alongside systemic therapy. Emerging evidence suggests cytoreductive therapies, like surgery or radiation, could improve survival for these patients.
Area of Science:
- Oncology
- Urology
Background:
- Oligometastatic prostate cancer is characterized by 5 or fewer metastatic lesions.
- Current treatment involves androgen deprivation therapy and systemic agents.
- The management paradigm is shifting towards incorporating local therapies for select patients.
Purpose of the Study:
- To review the biological and clinical rationale for local therapy in oligometastatic prostate cancer.
- To summarize current evidence supporting local treatment approaches.
- To compare the designs of ongoing clinical trials investigating local therapies.
Main Methods:
- Review of retrospective studies on cytoreductive therapy, including radical prostatectomy.
- Analysis of phase 2 randomized trials evaluating local radiation therapy.
- Comparison of ongoing randomized trials assessing cytoreductive therapy versus standard care.
Main Results:
- Retrospective data suggest cytoreductive therapy, such as radical prostatectomy, may enhance overall survival.
- Phase 2 trials have explored radiation as a local therapy option.
- Ongoing trials are actively comparing local cytoreductive treatments with standard systemic therapies.
Conclusions:
- Local therapy for the prostate is an emerging concept in oligometastatic prostate cancer management.
- Evidence suggests potential survival benefits from cytoreductive interventions.
- Further research through ongoing randomized trials is crucial to establish definitive treatment guidelines.
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