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Trends in Management of Oligometastatic Hormone-Sensitive Prostate Cancer

  • Genitourinary Cancers (DP Petrylak and JW Kim, Section Editors)
  • Published:
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Abstract

Purpose of Review

Systemic therapy for patients with hormone-sensitive oligometastatic prostate cancer is non-curative and associated with toxicities. Meanwhile, this population presents unique clinical opportunities to improve outcomes, including the demonstrated benefits of radiotherapy to the primary tumor or oligometastatic sites.

Recent Findings

Recently published randomized studies have demonstrated benefits with the addition of radiotherapy to the primary disease or metastatic lesions in patients with synchronous or metachronous disease. The introduction of novel PET imaging has improved the sensitivity and specificity for detecting metastatic disease and provides an opportunity to better select patients who will benefit from local therapy.

Summary

The data presented in this review supports revisiting practice guidelines for patients with hormone-sensitive metastatic prostate cancer, particularly in relation to the role of radiotherapy to the primary tumor and sites of oligometastatic disease. Future trials will aim to further establish the role of metastasis-directed therapies in metachronous, synchronous, and castrate-resistant disease.

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Funding

Alison C. Tree and Nicholas J. van As “This paper represents independent research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.”

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Authors and Affiliations

  1. Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia

    Gargi Kothari & Shankar Siva

  2. Peter MacCallum Cancer Center, Melbourne, Victoria, Australia

    Gargi Kothari & Shankar Siva

  3. Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Piet Ost

  4. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Ave TG 260, Toronto, ON, M4N 3M5, Canada

    Patrick Cheung & Andrew Loblaw

  5. Gustave-Roussy, Radiotherapy Department, Paris-Saclay University, 114 Rue Edouard Vaillant, F-94800, Villejuif, France

    Pierre Blanchard

  6. Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK

    Alison C. Tree & Nicholas J. van As

  7. Department of Radiation Oncology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, 98195, USA

    Simon S. Lo

  8. Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA

    Drew Moghanaki

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  1. Gargi Kothari
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  9. Andrew Loblaw
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  10. Shankar Siva
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Correspondence to Shankar Siva.

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Conflict of Interest

Gargi Kothari declares that he has no conflict of interest.

Piet Ost declares that he has no conflict of interest.

Patrick Cheung is supported by an investigator-initiated industry research grant (to fund a current Phase I/II trial in hormone-sensitive oligometastatic prostate cancer) from AbbVie.

Pierre Blanchard has received research support through grants from Astellas and Amgen.

Alison C. Tree has received research support through grants from MSD and Elekta, and has received compensation from Bayer, Astellas, Janssen, and Ferring Pharmaceuticals for service as a consultant.

Nicholas J. van As has received both research grants as well as compensation for service as a consultant from Accuray.

Simon S. Lo served as an expert group member for the Elekta ICON and also received partial research support from Elekta for the International Oligometastasis Consortium (ended in July 2016).

Drew Moghanaki has received reimbursement for travel expenses and compensation for service as a consultant from Varian Medical Systems.

Andrew Loblaw has received research support through grants from AbbVie, Astellas, Janssen, Sanofi, AstraZeneca, and TerSera Therapeutics; has received compensation from AbbVie, Bayer, Astellas, Janssen, Sanofi, AstraZeneca, and TerSera Therapeutics for service as a consultant; has received non-financial support from Astellas, Janssen, AstraZeneca, and TerSera Therapeutics; and has a patent issued on a prostate immobilization device.

Shankar Siva has received research support through grants from Varian Medical Systems and MSD; has received compensation from AstraZeneca, Bristol-Myers Squibb, Astellas, Roche, and Janssen for service on advisory boards; and has received reimbursement for travel expenses from AstraZeneca Bristol-Myers Squibb, and Astellas.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Genitourinary Cancers

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Kothari, G., Ost, P., Cheung, P. et al. Trends in Management of Oligometastatic Hormone-Sensitive Prostate Cancer. Curr Oncol Rep 21, 43 (2019). https://doi.org/10.1007/s11912-019-0791-5

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