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Management of oligometastatic prostate cancer

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memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Summary

Purpose

This study aimed to review the current management strategies for oligometastatic prostate cancer (omPCa), focusing on their clinical implications.

Materials and methods

A narrative review method was adopted, synthesizing the leading evidence on issues associated with omPCa management.

Results

Androgen deprivation therapy (ADT) remains fundamental in omPCa. Combination with androgen receptor signalling inhibitors (ARSI) and/or chemotherapy were found to improve survival. Triplet therapy can be considered a new standard of care; however, no direct comparison with ADT + ARSI doublet exists. There is a trend towards patient-tailored decisions for optimal systemic treatment, mainly based on clinical data such as disease volume. For low-volume omPCa patients, local radiotherapy showed modest survival improvement and should be considered as a part of multimodality treatment. Cytoreductive radical prostatectomy is promising but remains investigational. Metastases-directed therapy (MDT) can be used to delay the initiation of ADT in metachronous omPCa patients. Although promising, insufficient data exist to conclusively prove that MDT benefits major oncologic outcomes in the context of treatment intensification. In scenarios where MDT could preclude therapies supported by high-quality evidence, the choice of the best systemic treatment should precede MDT.

Conclusion

The increased detection of omPCa due to advanced imaging necessitates an evolving treatment paradigm, encompassing systemic therapies, local treatments, and MDT. Current treatments largely rely on clinical disease burden and timing. We anticipate that diagnostic advancements and ongoing research will pave the way for personalized treatment options in omPCa management.

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Author information

Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Marcin Miszczyk, Fahad Quhal, Jakob Klemm, Akihiro Matsukawa, Shahrokh F. Shariat & Paweł Rajwa

  2. 3rd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice branch. ul. Wybrzeża Armii Krajowej 15, 44-100, Gliwice, Poland

    Marcin Miszczyk

  3. Department of General, Oncological and Functional Urology, Medical University of Warsaw, Williama Heerleina Lindleya 4, 02-005, Warsaw, Poland

    Aleksander Slusarczyk

  4. Department of Urology, King Fahad Specialist Hospital, Ammar Bin Thabit St. Al Merikbat neighborhood, 32253, Dammam, Saudi Arabia

    Fahad Quhal

  5. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany

    Jakob Klemm

  6. Department of Urology, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, Japan

    Akihiro Matsukawa

  7. Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688, Krakow, Poland

    Mikołaj Przydacz

  8. Department of Urology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 3 Maja 13–15, 41-800, Zabrze, Poland

    Piotr Bryniarski & Paweł Rajwa

  9. Karl Landsteiner Institute of Urology and Andrology, Rathausstraße 21, 1010, Vienna, Austria

    Shahrokh F. Shariat

  10. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, 19328, Amman, Jordan

    Shahrokh F. Shariat

  11. Department of Urology, University of Texas Southwestern Medical Center, Harry Hines Blvd., 5323, Dallas, TX, USA

    Shahrokh F. Shariat

  12. Department of Urology, Weill Cornell Medical College, 38 6th Avenue, 2nd floor, 11217, Brooklyn, NY, USA

    Shahrokh F. Shariat

  13. Department of Urology, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic

    Shahrokh F. Shariat

Authors
  1. Marcin Miszczyk
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  2. Aleksander Slusarczyk
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  3. Fahad Quhal
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  4. Jakob Klemm
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  5. Akihiro Matsukawa
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  6. Mikołaj Przydacz
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  7. Piotr Bryniarski
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  8. Shahrokh F. Shariat
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  9. Paweł Rajwa
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Corresponding author

Correspondence to Paweł Rajwa.

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Conflict of interest

Shahrokh F. Shariat received as follows: Honoraria: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Roche, and Takeda; Consulting or Advisory Role: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Pierre Fabre, Roche, and Takeda; Speakers Bureau: Astellas, Astra Zeneca, Bayer, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Richard Wolf, Roche, and Takeda. M. Miszczyk, A. Slusarczyk, F. Quhal, J. Klemm, A. Matsukawa, M. Przydacz, P. Bryniarski and P. Rajwa declare that they have no competing interests.

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Miszczyk, M., Slusarczyk, A., Quhal, F. et al. Management of oligometastatic prostate cancer. memo 17, 35–39 (2024). https://doi.org/10.1007/s12254-023-00938-6

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  • DOI: https://doi.org/10.1007/s12254-023-00938-6

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