This review aims to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa).
We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: (prostate cancer OR prostate carcinoma OR prostate neoplasm OR prostate tumor OR prostate tumour) AND (oligometastatic OR oligometastasis OR PSMA) AND (surgery OR prostatectomy OR radical prostatectomy OR cytoreductive OR local treatment OR radiotherapy OR stereotactic OR stereotaxic) AND (survival OR mortality).
After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomised studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomised controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomised phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear.
We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2020 Jun 16 [Epub ahead of print]
Noriyoshi Miura, Benjamin Pradere, Keiichiro Mori, Hadi Mostafaei, Fahad Quhal, Vincent Misrai, David D'andrea, Simone Albisinni, Rocco Papalia, Takashi Saika, Roberto M Scarpa, Shahrokh F Shariat, Francesco Esperto
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria - ., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, Clinique Pasteur, Toulouse, France., Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium., Department of Urology, Campus Biomedico University of Rome, Rome, Italy., Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan., EAU Young Urologist Office (YOU), Arnhem, the Netherlands.