Presentation: Dr. De Meerleer, a radiation oncologist, provided insight into the role metastases-directed therapy (MDT) in the setting of oligometastatic prostate cancer. First, this is a rare situation still – cN+M+ on PSMA/PET but cN0M0 on conventional imaging is not that common.
At his institution, this patient would NOT get systemic therapy (except as an adjunct to RT). The patient would be recommended for radical prostatectomy with ePLND (due to presacral node), XRT to the pelvis and nodal region, followed by RT to the two other sides (iliac bone and rib).
He touched upon a recent publication (Ost Clinical Oncology 2016) done at his institution which demonstrated that repeat SBRT to oligometastatic sites was able to provide 44 months median ADT-free survival (almost 4 years), which has significant clinical impact on the patient. However, no specific correlation to CSS or OS. They did have 5-year PCa specific survival of 98%. It was also well tolerated.
However, there has been criticism of this approach by other groups. Murphy EU 2017 ("Gotta Catch 'em All", or Do We? Pokemet Approach to Metastatic Prostate Cancer.”) specifically emphasized that this is an experimental approach and not standard of care.
STOMP trial – first randomized trial to assess metastases-direct RT vs. surveillance for oligometastatic disease (Ost JCO 2017). In this smaller study, there was an 8-month median ADT-free survival benefit.
He was quite confident that this is best approach for the patient.
Dr. Mottet, head of the prostate cancer guidelines committee for the EAU, had a more sobering view of the situation. He made it very clear that this is experimental and should be done only on trial. He appropriately raised the concern of lead-time bias in PSMA-detected oligometastatic disease.
Presented by: Gert De Meerleer, MD, Ghent, Belgium
Written by: Thenappan Chandrasekar, MD Clinical Fellow, University of Toronto, twitter: @tchandra_uromd at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark
Read More Treatment Options for this Case Presented at EAU 2018:
Treatment Option: Systemic Therapy is the Standard of Care - Silke Gillessen Sommer, MD, St. Gallen, Switzerland
Treatment Option: Local Control is Needed - Steven Joniau, MD, PhD