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Oligoprogression in Metastatic, Castrate-Resistant Prostate Cancer-Prevalence and Current Clinical Practice.

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Summary

Oligoprogression occurs in nearly a third of prostate cancer patients on androgen receptor-targeted therapy (ARTT). Oligoprogressive disease (OPD) patients showed better treatment response, and many had lesions suitable for stereotactic body radiotherapy (SBRT).

Keywords:
Androgen receptor targeted therapyOligoprogressive disease (OPD)abirateronecastrate resistant prostate cancerenzalutamideoligoprogressionstereotactic body radiotherapy

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Area of Science:

  • Oncology
  • Radiotherapy
  • Prostate Cancer Research

Background:

  • Oligoprogression (OPD) in castration-resistant prostate cancer (CRPC) on androgen receptor-targeted therapy (ARTT) is poorly understood.
  • The natural history and clinical significance of OPD during ARTT require further investigation.

Purpose of the Study:

  • To determine the prevalence of oligoprogression in CRPC patients treated with ARTT.
  • To characterize oligoprogressive disease and assess its natural history.
  • To identify patients with OPD potentially amenable to stereotactic body radiotherapy (SBRT).

Main Methods:

  • Retrospective analysis of electronic patient records for CRPC patients who progressed on ARTT.
  • Identification of patients with oligoprogressive disease (≤3 lesions).
  • Kaplan-Meier method and log-rank test for survival analysis.

Main Results:

  • Twenty-nine percent of 102 CRPC patients on ARTT exhibited oligoprogression.
  • Oligoprogressive patients had a better initial prostate-specific antigen (PSA) response to ARTT compared to polyprogressive patients.
  • Seventy percent of oligoprogressive lesions were suitable for SBRT, with a median progression-free survival of 13.6 months post-SBRT versus 5.7 months with continued ARTT alone.

Conclusions:

  • Oligoprogression is a significant pattern of progression in nearly a third of CRPC patients on ARTT.
  • Patients with OPD demonstrate distinct characteristics, including better initial PSA response.
  • A substantial proportion of OPD patients may benefit from SBRT, warranting further investigation in prospective trials.