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Metastasis-directed therapy (MDT) shows promise for oligometastatic prostate cancer (OMPC). Evidence supports MDT, especially stereotactic body radiotherapy (SBRT), in delaying progression and improving survival for selected OMPC patients.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urology

Background:

  • Oligometastatic prostate cancer (OMPC) presents a limited metastatic burden, with distinct subtypes including de novo oligometastatic hormone-sensitive prostate cancer (om-HSPC), metachronous oligorecurrent HSPC (or-HSPC), and oligoprogressive castrate-resistant prostate cancer (op-CRPC).
  • Metastasis-directed therapy (MDT), particularly stereotactic body radiotherapy (SBRT), is increasingly utilized for its noninvasive approach to delay progression, achieve local control, and preserve quality of life (QoL).

Purpose of the Study:

  • To review the current evidence supporting the integration of MDT across the spectrum of OMPC subtypes.
  • To evaluate the efficacy and safety of MDT, including SBRT and elective nodal radiotherapy (ENRT), in managing OMPC.
  • To identify emerging biomarkers for patient selection and personalized treatment strategies in OMPC.

Main Methods:

  • Review of prospective studies, randomized trials (STOMP, ORIOLE, PEACE V-STORM), meta-analyses (WOLVERINE), and clinical trials (EXTEND, RADIOSA) examining MDT in OMPC.
  • Analysis of treatment outcomes including progression-free survival (PFS), overall survival, biochemical control, locoregional control, and quality of life (QoL).
  • Exploration of patient selection criteria, including PSA kinetics, PSMA-PET findings, and genomic factors.

Main Results:

  • Randomized trials confirm SBRT-MDT safely delays systemic therapy initiation and prolongs PFS in or-HSPC.
  • Elective nodal radiotherapy (ENRT) demonstrated superior control compared to SBRT alone in nodal or-HSPC (PEACE V-STORM).
  • Systemically augmented MDT shows durable responses and improved outcomes with no added QoL detriment in selected OMPC patients (EXTEND, RADIOSA).
  • A meta-analysis (WOLVERINE) indicates MDT improves PFS and overall survival across OMPC subtypes.

Conclusions:

  • Current evidence supports the integration of MDT into clinical practice for appropriately selected OMPC patients.
  • Patient selection using biomarkers like PSA kinetics, PSMA-PET, and genomic factors is crucial for personalizing OMPC treatment.
  • Ongoing phase III trials are expected to further refine the role of MDT in OMPC management.