Metastasis-Directed Therapy for Oligometastatic Castration-Sensitive Prostate Cancer: An Alternative to ADT?

Curr Urol Rep. 2023 Jul;24(7):299-306. doi: 10.1007/s11934-023-01159-4. Epub 2023 Apr 5.

Abstract

Purpose of review: The standard treatment of patients with metastatic prostate cancer is systemic treatment with androgen-deprivation therapy (ADT). The spectrum-based model of metastatic disease includes the presence of an oligometastatic state, an intermediary between localized and widespread metastatic disease, in which radical local treatment might improve systemic control. Our purpose is to review the literature on metastasis-directed therapy in the treatment of oligometastatic prostate cancer.

Recent findings: Several prospective clinical trials have reported improvements in ADT-free survival and progression-free survival with metastasis-directed therapy of oligometastatic prostate cancer. Retrospective studies have found improvements in oncologic outcomes for patients with oligometastatic prostate cancer undergoing metastasis-directed therapy, and several recent prospective clinical trials have confirmed these results. Advancements in imaging as well as an understanding of the genomics of oligometastatic prostate cancer may allow for better patient selection for metastasis-directed therapy and the potential for cure in selected patients.

Keywords: Metastasis-directed therapy; Oligometastatic prostate cancer; Prostate cancer; Stereotactic body radiation therapy.

Publication types

  • Review

MeSH terms

  • Androgen Antagonists / therapeutic use
  • Castration
  • Humans
  • Male
  • Neoplasm Metastasis / drug therapy
  • Prospective Studies
  • Prostatic Neoplasms* / drug therapy
  • Prostatic Neoplasms* / pathology
  • Retrospective Studies

Substances

  • Androgen Antagonists