Oligometastatic Prostate and Bladder Cancer: An Integrative Narrative Review.

Area of Science:

• Oncology
• Radiotherapy
• Urologic Oncology

Background:

• Oligometastatic prostate cancer (OMPC) and oligometastatic bladder cancer (OMBC) represent intermediate stages of metastatic disease.
• Metastasis-directed therapy (MDT) is emerging as a viable strategy for selected patients with limited metastatic burden.

Purpose of the Study:

• To review contemporary evidence and provide practical guidance on image-guided patient selection for MDT in OMPC and OMBC.
• To integrate MDT into modern treatment paradigms for these conditions.

Main Methods:

• Narrative review of contemporary evidence.
• Focus on image-guided patient selection and MDT integration.
• Analysis of phase II randomized trials in OMPC and retrospective/prospective data in OMBC.

Main Results:

• In OMPC, MDT (commonly SBRT) prolongs progression-free survival and delays systemic therapy escalation with low toxicity.
• Prostate-specific membrane antigen (PSMA) PET/CT is vital for staging and restaging.
• In OMBC, MDT is a consolidation strategy for residual disease or oligoprogression, with limited survival data.

Conclusions:

• MDT offers significant benefits in OMPC, improving progression-free survival and treatment-free intervals.
• Successful MDT in both OMPC and OMBC requires harmonized definitions, precise lesion enumeration, and adherence to dose constraints.
• Future research should focus on biologically informed selection criteria and randomized trials to confirm survival benefits.