Systemic therapy for patients with hormone-sensitive oligometastatic prostate cancer is non-curative and associated with toxicities. Meanwhile, this population presents unique clinical opportunities to improve outcomes, including the demonstrated benefits of radiotherapy to the primary tumor or oligometastatic sites.
Recently published randomized studies have demonstrated benefits with the addition of radiotherapy to the primary disease or metastatic lesions in patients with synchronous or metachronous disease. The introduction of novel PET imaging has improved the sensitivity and specificity for detecting metastatic disease and provides an opportunity to better select patients who will benefit from local therapy. The data presented in this review supports revisiting practice guidelines for patients with hormone-sensitive metastatic prostate cancer, particularly in relation to the role of radiotherapy to the primary tumor and sites of oligometastatic disease. Future trials will aim to further establish the role of metastasis-directed therapies in metachronous, synchronous, and castrate-resistant disease.
Current oncology reports. 2019 Mar 27*** epublish ***
Gargi Kothari, Piet Ost, Patrick Cheung, Pierre Blanchard, Alison C Tree, Nicholas J van As, Simon S Lo, Drew Moghanaki, Andrew Loblaw, Shankar Siva
Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia., Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium., Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Ave TG 260, Toronto, ON, M4N 3M5, Canada., Gustave-Roussy, Radiotherapy Department, Paris-Saclay University, 114 Rue Edouard Vaillant, F-94800, Villejuif, France., Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK., Department of Radiation Oncology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, 98195, USA., Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA., Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia. .