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Debate 3: Oligometastatic Hormone Sensitive Prostate Cancer Management: Systemic Therapy Approach.

Gunhild von Amsberg1, Moritz Kaune2, Anja Coym2

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Systemic therapy is recommended for oligometastatic prostate cancer (OMPC) despite ongoing debate. While metastasis-directed therapy (MDT) shows promise, current evidence favors systemic treatments for better survival outcomes in OMPC.

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Area of Science:

  • Oncology
  • Urology

Background:

  • Oligometastatic prostate cancer (OMPC) presents an intermediate stage of disease with limited metastatic lesions.
  • The optimal treatment strategy for OMPC, balancing metastasis-directed therapy (MDT) and systemic therapy, remains controversial.
  • Current challenges include a lack of standardized OMPC definition, imaging inconsistencies, and unclear biological underpinnings.

Purpose of the Study:

  • To critically evaluate the current evidence supporting systemic therapy versus MDT for OMPC.
  • To highlight the strengths of systemic therapy and weaknesses of local treatment data in OMPC.
  • To discuss the complexities and future research directions in OMPC management.

Main Methods:

  • Review and analysis of existing clinical trial data and subgroup analyses.
  • Discussion of imaging modalities and their impact on OMPC classification.
  • Evaluation of the biological basis and biomarker potential in OMPC.

Main Results:

  • Metastasis-directed therapy (MDT) has shown benefits in progression-free survival but not conclusively in overall survival.
  • Systemic therapy, particularly androgen receptor pathway inhibitors (ARPIs), has demonstrated significant survival advantages in phase 3 trials for OMPC.
  • Subgroup analyses suggest systemic therapy benefits are pronounced in low-volume OMPC.

Conclusions:

  • Systemic therapy is currently considered the standard of care for OMPC due to demonstrated survival benefits.
  • Further research is essential to refine patient selection, integrate biomarkers, and optimize combination strategies.
  • Addressing definition standardization and imaging inconsistencies is crucial for advancing OMPC treatment paradigms.