Oligometastatic prostate cancer - bridging the gap between localized and metastatic disease

The understanding of oligometastatic prostate cancer has advanced substantially in the past two decades, reshaping both diagnostic and therapeutic paradigms. The advent of next-generation imaging, particularly prostate-specific membrane antigen PET-CT, has improved staging accuracy, enabling patients with limited metastatic burden who might benefit from intensified local and metastasis-directed approaches to be identified. Results from randomized phase II trials support the use of metastasis-directed therapy in patients with metachronous oligometastatic prostate cancer. However, evidence for metastasis-directed therapy in de novo presentations remains preliminary but encouraging. In parallel, prostate-directed treatments such as radiotherapy and cytoreductive radical prostatectomy are under active investigation, although the role of these approaches in the era of intensified systemic therapy is yet to be fully defined. Although interest around oligometastatic prostate cancer is growing, several issues are currently unsettled, including a unified definition of oligometastatic prostate cancer; the inclusion of biological information in patient selection; optimal treatment sequencing, including the integration and duration of systemic therapy; and appropriate clinical end points.