Management of Oligometastatic Prostate Cancer.

Abstract

Metastatic prostate cancer has long been considered incurable and managed with systemic therapies alone. However, there is increasing evidence of an “oligometastatic” state where patients with low-volume metastatic disease may achieve sustained disease-free intervals as well as potentially improved overall survival (OS) with combinations of systemic and local therapy. The concept of oligometastatic disease was first described by Hellman and Weichselbaum who hypothesized that there may be an intermediate state between locally confined disease and fulminant metastatic disease.1 Accordingly, recent data suggests that aggressive treatment of the primary tumor or metastasis-directed therapy (MDT) may confer a survival advantage in carefully selected patients with metastatic prostate cancer.2-4 Among the 190,000 new cases of prostate cancer diagnosed each year in the US, about 20% present with primary metastatic disease.5,6 Prostate-specific antigen (PSA) screening and imaging advances have led to a relative increase in the detection of cases with early metastatic disease. Even after detection of distant metastases (DM), metastatic prostate cancer is relatively indolent and marked by a long disease course.7 Due to its long natural history, prostate cancer has been at the forefront of efforts investigating aggressive treatment in oligometastatic disease. In this review we aim to outline treatment approaches for these patients, while highlighting existing literature, ongoing trials, and important areas for future study.