Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations

The oligometastatic state has been proposed as an intermediate stage of cancer spread between localized disease and widespread metastases. With improvements in diagnostic modalities such as functional imaging, oligometastatic prostate cancer is being diagnosed with greater frequency than ever before. Furthermore, the paradigm for treatment of advanced prostate cancers is shifting toward a more aggressive approach. Many questions surround the understanding of the process and consequences of oligometastasis, meaning that the contemporary literature offers a wide variety of definitions of oligometastatic prostate cancer. Until genomic data exist to provide a biological component to the definition of oligometastatic disease, a clinical diagnosis made on the basis of up to five extrapelvic lesions is reasonable for use. Retrospective studies suggest that interventions such as radical prostatectomy and local or metastasis-directed radiotherapy can be performed in the metastatic setting with minimal risk of toxic effects. These therapies seem to decrease the need for subsequent palliative interventions, but insufficient data are available to draw reliable conclusions regarding their effect on survival. Thus, a protocol for clinicians to manage the patient presenting with oligometastatic prostate cancer would be a useful clinical tool.

Nature reviews. Urology. 2016 Oct 11 [Epub ahead of print]

Jeffrey J Tosoian, Michael A Gorin, Ashley E Ross, Kenneth J Pienta, Phuoc T Tran, Edward M Schaeffer

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Marburg 134, Baltimore, MD 21287, USA., Department of Radiation Oncology &Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Weinberg Building, Ground Floor Room 1389A, Baltimore, MD 21231, USA., Department of Urology, Northwestern University, 303 East Chicago Avenue, Tarry Building 16-713, Chicago, Illinois 60611, USA.

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