Oligometastatic and Oligoprogression Disease and Local Therapies in Prostate Cancer

Abstract

Our understanding of metastatic disease is rapidly advancing, with recent evidence supporting an oligometastatic state currently defined by patients having a limited (typically ≤5) number of metastatic deposits. The optimal management of these patients is also shifting toward increased integration of local therapies, with emerging evidence suggesting metastasis-directed therapy can improve overall survival. Additionally, the use of stereotactic ablative radiation therapy within castration-sensitive oligometastatic prostate cancer cohorts appears to forestall the need to initiate systemic therapy, which has unfavorable side effect profiles, such as androgen deprivation therapy, while itself being associated with little toxicity. We review the literature surrounding the use of metastasis-directed therapy in the treatment of oligometastatic prostate cancer by reviewing the evidence for its use within 3 subgroups: de novo synchronous, oligorecurrent, and oligoprogressive disease.

Figure 1:

Spectrum of metastatic disease As the number of metastatic lesions increases the role of local therapy has historically been less important, however local therapy in oligometastatic disease appears to improve oncologic outcomes

Figure 2:

Classes of failure following metastasis directed therapy Following metastasis directed therapy patients can be divided into those with long term control, oligoprogressors with limited number of recurrence sites, and polyprogressors with numerous sites of recurrence.