What is the ideal combination therapy in de novo, oligometastatic, castration-sensitive prostate cancer?

To review current evidence regarding the management of de novo, oligometastatic, castration-sensitive prostate cancer (PCa).

A literature search was conducted on PubMed/Medline and a narrative synthesis of the evidence was performed in August 2022.

Oligometastatic disease is an intermediate state between localized and aggressive metastatic PCa defined by ≤ 3-5 metastatic lesions, although this definition remains controversial. Conventional imaging has limited accuracy in detecting metastatic lesions, and the implementation of molecular imaging could pave the way for a more personalized treatment strategy. However, oncological data supporting this strategy are needed. Radiotherapy to the primary tumor should be considered standard treatment for oligometastatic PCa (omPCa). However, it remains to be seen whether local therapy still has an additional survival benefit in patients with de novo omPCa when treated with the most modern systemic therapy combinations. There is insufficient evidence to recommend cytoreductive radical prostatectomy as local therapy; or stereotactic body radiotherapy as metastasis-directed therapy in patients with omPCa. Current data support the use of intensified systemic therapy with androgen deprivation therapy (ADT) and next-generation hormone therapies (NHT) for patients with de novo omPCa. Docetaxel has not demonstrated benefit in low volume disease. There are insufficient data to support the use of triple therapy (i.e., ADT + NHT + Docetaxel) in low volume disease.

The present review discusses current data in de novo, omPCa regarding its definition, the increasing role of molecular imaging, the place of local and metastasis-directed therapies, and the intensification of systemic therapies.

World journal of urology. 2022 Dec 09 [Epub ahead of print]

Michael Baboudjian, Guilhem Roubaud, Gaëlle Fromont, Mathieu Gauthé, Jean-Baptiste Beauval, Eric Barret, Laurent Brureau, Gilles Créhange, Charles Dariane, Gaëlle Fiard, Romain Mathieu, Alain Ruffion, Morgan Rouprêt, Raphaële Renard-Penna, Paul Sargos, Guillaume Ploussard, Prostate Cancer Committee of the French Association of Urology

Department of Urology, APHM, North Academic Hospital, Marseille, France. ., Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France., Department of Pathology, CHRU Tours, Tours, France., Department of Nuclear Medicine, Scintep-Institut Daniel Hollard, Grenoble, France., Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97110, Pointe-à-Pitre, France., Department of Radiotherapy, Institut Curie, Paris, France., Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris-Paris University-U1151 Inserm-INEM, Necker, Paris, France., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France., Department of Urology, CHU Rennes, Rennes, France., Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013, Paris, France., Sorbonne University, AP-HP, Radiology, Pitie-Salpetriere Hospital, 75013, Paris, France., Department of Radiotherapy, Institut Bergonié, 33000, Bordeaux, France.