Where Do We Stand in the Management of Oligometastatic Prostate Cancer? A Comprehensive Review

Abstract

Oligometastatic prostate cancer (OMPC) is an intermediate state between localised disease and widespread metastases that includes a spectrum of disease biology and clinical behaviours. This narrative review will cover the current OMPC scenario. We conducted comprehensive English language literature research for original and review articles using the Medline database and grey literature through December 2021. OMPC is a unique clinical state with inherently more indolent tumour biology susceptible to multidisciplinary treatment (MDT). With the development of new imaging techniques, patients with OMPC are likely to be identified at an earlier stage, and the paradigm for treatment is shifting towards a more aggressive approach to treating potentially curable patients. Multimodal management is necessary to improve patient outcomes due to the combination of available therapies, such as local therapy of primary tumour, metastasis directed therapy or systemic therapy, to reduce tumour load and prevent further disease progression. Additional prospective data are needed to select patients most likely to benefit from a given therapeutic approach.

Keywords: local therapy; metastasis-directed treatment; new imaging techniques; oligometastatic; prostate cancer; systemic therapy.

Figure 1

Natural history of oligometastatic prostate cancer. Prostate cancer is split into different clinical states (hormone-sensitive disease shown in blue and castration-resistant disease shown in green) with progressively increasing total tumour burden (represented by the arrows). Below, the different therapeutic options for each of the states are shown. Abbreviations: RT, radiotherapy; M0, non-metastatic disease; ADT, androgen deprivation therapy; MDT, metastasis directed therapy; SBRT, stereotactic body radiotherapy; M1, metastatic disease; PARPi, poly ADP ribose polymerase enzyme inhibitors.