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Updated: May 10, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Metastasis-Directed Therapy in Oligometastatic Prostate Cancer: Biological Rationale and Systematic Review of
Francesco Fiorica1,2, Teodoro Sava2, Jacopo Giuliani2
1Department of Clinical Oncology, Section of Radiation Oncology and Nuclear Medicine, AULSS 9 Scaligera, 37122 Verona, Italy.
Introduction:
Metastasis-directed therapy (MDT) alone may be effective in preventing disease progression and positively affecting overall survival (OS) in oligometastatic prostate cancer (OMPC).
Objective:
We systematically reviewed the current literature to analyse the biological rationale for integrating MDT into treatment strategies for OMPC and investigate the current evidence on its role in OMPC.
Evidence Acquisition:
MEDLINE/PUBMED and the EMBASE Database were systematically searched to identify eligible reports published up to January 2024. The proceedings of the European Society for Radiotherapy and Oncology, European Society of Medical Oncology, American Society for Radiation Oncology, American Society of Clinical Oncology, European Uro-Oncology Group, and American Urological Association annual meetings were analysed.
Results:
Eighteen studies published between 2014 and 2024 were selected for the analysis. The studies included 1058 patients treated with metastasis-directed radiotherapy. No statistically significant differences were found in terms of treatment-escalation-free survival between hormone-naïve patients treated with MDT alone and those treated with MDT and hormonal manipulation. By contrast, the combination treatment significantly increased both 2 year and 4 year disease-progression-free survival (DPFS) rates (p-values < 0.00001 and 0.006, respectively). In patients with castration-sensitive disease treated with MDT alone, the estimated 2 year and 4 year OS rates were 96.4% (95% confidence interval [CI], 92.9-100%) and 89.1% (95% CI, 82.3-96.5%), respectively. The estimated 2 year and 4 year overall survival rates in the combination treatment group were 86.1% (95% CI 79.2-93.7%) and 74.8% (95% CI 64.6.3-86.5%), respectively.
Conclusions:
MDT alone is associated with promising outcomes in OMPC and represents a valuable, valid, and often preferable strategy. Combined with ADT improves significantly disease-progression-free survival, but its impact on overall survival remains uncertain. Given these findings, the decision to incorporate ADT should be tailored to individual patient characteristics and clinical context. Future research should integrate biomarker-based approaches to optimise MDT use and select the best candidates for a multimodal approach.
Insights
Metastasis-directed therapy (MDT) alone shows promise for oligometastatic prostate cancer (OMPC). Combining MDT with androgen deprivation therapy (ADT) improves disease progression-free survival but its effect on overall survival is uncertain.
Area of Science:
- Oncology
- Radiation Oncology
- Uro-Oncology
Background:
- Metastasis-directed therapy (MDT) may prevent disease progression and improve survival in oligometastatic prostate cancer (OMPC).
- The biological rationale for integrating MDT into OMPC treatment strategies requires further investigation.
- Current evidence on the role of MDT in OMPC needs systematic evaluation.
Purpose of the Study:
- To systematically review the literature on MDT for OMPC.
- To analyze the biological rationale for integrating MDT into OMPC treatment.
- To investigate the current evidence on the role of MDT in OMPC.
Main Methods:
- Systematic literature search of MEDLINE/PUBMED and EMBASE databases up to January 2024.
- Analysis of proceedings from major oncology and urology society annual meetings.
- Inclusion of 18 studies published between 2014 and 2024, involving 1058 patients treated with metastasis-directed radiotherapy.
Main Results:
- MDT alone demonstrated promising outcomes in OMPC patients.
- Combination of MDT and androgen deprivation therapy (ADT) significantly improved 2-year and 4-year disease-progression-free survival (DPFS) rates (p < 0.00001 and p = 0.006).
- No significant difference in treatment-escalation-free survival was observed between MDT alone and MDT plus hormonal manipulation in hormone-naïve patients. Overall survival (OS) rates were higher with MDT alone compared to combination therapy in castration-sensitive disease.
Conclusions:
- MDT alone is a valuable and often preferable strategy for OMPC.
- Combined MDT and ADT significantly enhances DPFS but its impact on OS remains uncertain.
- Future research should focus on biomarker-based approaches to optimize MDT use and patient selection for multimodal therapy.
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