Treatment Strategies in Oligo-Metastatic Prostate Cancer: A Nationwide Survey

Introduction: Metastasis-directed therapy (MDT) is a promising approach for recurrent or de novo oligo-metastatic castration-sensitive prostate cancer (omCSPC). The aim of this study was to evaluate the treatment approaches in omCSPC among German physicians.

An anonymous online questionnaire was sent via survio.com to the members of the German Societies of Urology and Radiooncology.

Participants (n = 166; 33% urologists, 66% radiooncologists) define omCSPC as ≤3 (31%) or ≤4 (58%) metastases. Multimodal therapy consisting of local therapy of the primary tumor, MDT, and androgen deprivation therapy (ADT) was favored. For local therapy, radiotherapy was the preferred approach (radiotherapy: 84%, prostatectomy: 16%). Overall, 77% and 76% considered MDT as (very) highly important in synchronous and metachronous omCSPC, respectively. In total, 80% would complement MDT with time-limited ADT. Compared to urologists, radiooncologists more often include cases with ≥3 metastases (p = 0.006) and see a higher importance of radiotherapy (p = 0.023), a lower importance of prostatectomy (p < 0.001) as well as a higher importance of MDT (in de novo p = 0.038, in metachronous p = 0.010).

MDT with time-limited ADT is a common treatment strategy in omCSPC. Especially in synchronous omCSPC, radiotherapy as local treatment for the primary is the preferred option rather than radical prostatectomy.