Local therapy for oligometastatic prostate cancer

Area of Science:

• Oncology
• Radiotherapy
• Medical Imaging

Background:

• Metastatic prostate cancer traditionally treated with androgen deprivation therapy (ADT).
• Local therapies for metastatic lesions were rarely used.
• Next-generation imaging (e.g., PSMA-PET) now detects previously undetectable oligometastases.

Purpose of the Study:

• To review the role and evidence for local therapies in oligometastatic prostate cancer.
• To highlight the impact of advanced imaging on treatment strategies.
• To discuss the future of local therapy in managing prostate cancer metastases.

Main Methods:

• Review of evidence from randomized controlled trials (RCTs) including STAMPEDE, STOMP, ORIOLE, and ARTO.
• Analysis of the impact of advanced imaging modalities like PSMA-PET.
• Classification of oligometastatic prostate cancer into de novo, oligorecurrent, and oligoprogressive types.

Main Results:

• The STAMPEDE trial showed adding prostate radiotherapy to ADT improved overall survival in de novo low-volume metastatic prostate cancer.
• STOMP and ORIOLE trials demonstrated metastasis-directed therapy significantly prolongs progression-free survival (PFS) in oligorecurrent prostate cancer.
• The ARTO trial indicated adding radiotherapy to oligometastases improved PFS in oligoprogressive castration-resistant prostate cancer.

Conclusions:

• Local therapies are increasingly important for oligometastatic prostate cancer, supported by RCT evidence.
• Advanced imaging like PSMA-PET facilitates the identification and treatment of oligometastases.
• Local therapy for primary tumors and metastases is expected to be a prominent future strategy.