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. 2025 Apr 14:1-10.
doi: 10.1159/000545630. Online ahead of print.

Treatment Strategies in Oligo-Metastatic Prostate Cancer: A Nationwide Survey

Angelika Borkowetz  1   2 , Bernd Wullich  2   3   4   5 , Matthias Saar  2   6 , Nina Schmidt-Hegemann  7 , Johannes Linxweiler  2   8   9
Affiliations

Treatment Strategies in Oligo-Metastatic Prostate Cancer: A Nationwide Survey

Angelika Borkowetz et al. Urol Int. .

Abstract

Introduction: Metastasis-directed therapy (MDT) is a promising approach for recurrent or de novo oligo-metastatic castration-sensitive prostate cancer (omCSPC). The aim of this study was to evaluate the treatment approaches in omCSPC among German physicians.

Methods: An anonymous online questionnaire was sent via <ext-link ext-link-type="uri" xlink:href="http://survio.com" xmlns:xlink="http://www.w3.org/1999/xlink">survio.com</ext-link> to the members of the German Societies of Urology and Radiooncology.

Results: Participants (n = 166; 33% urologists, 66% radiooncologists) define omCSPC as ≤3 (31%) or ≤4 (58%) metastases. Multimodal therapy consisting of local therapy of the primary tumor, MDT, and androgen deprivation therapy (ADT) was favored. For local therapy, radiotherapy was the preferred approach (radiotherapy: 84%, prostatectomy: 16%). Overall, 77% and 76% considered MDT as (very) highly important in synchronous and metachronous omCSPC, respectively. In total, 80% would complement MDT with time-limited ADT. Compared to urologists, radiooncologists more often include cases with ≥3 metastases (p = 0.006) and see a higher importance of radiotherapy (p = 0.023), a lower importance of prostatectomy (p < 0.001) as well as a higher importance of MDT (in de novo p = 0.038, in metachronous p = 0.010).

Conclusion: MDT with time-limited ADT is a common treatment strategy in omCSPC. Especially in synchronous omCSPC, radiotherapy as local treatment for the primary is the preferred option rather than radical prostatectomy.

Keywords: Metastasis-directed therapy; National survey study; Oligo-metastatic prostate cancer; Prostate-specific membrane antigen-positron emission tomography imaging; Radiotherapy; Systemic treatment.

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Conflict of interest statement

Angelika Borkowetz and Bernd Wullich were members of the journal’s Editorial Board at the time of submission. The remaining authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
a Imaging performed in newly diagnosed high-risk PCa and biochemical recurrence. b Definition of oligo-metastatic PCa by imaging. CT, computed tomography; FDG, fluorodeoxyglucose; MRI, magnetic resonance imaging; PCa, prostate cancer; PET, positron emission tomography; PSMA, prostate-specific membrane antigen; SPECT, single photon emission computed tomography.
Fig. 2.
Fig. 2.
Treatment approaches in synchronous (dark bars) and metachronous (light bars) oligo-metastatic PCa. ADT, androgen deprivation therapy; MDT, metastasis-directed therapy; NHT, new hormonal therapy.
Fig. 3.
Fig. 3.
a Criteria considered for the choice pro/con local therapy +/− MDT. b Endpoints relevant for therapy decision in patients with oligo-metastatic PCa. MDT, metastasis-directed therapy; PROMs, patient-reported outcome measurements; PSA, prostate-specific antigen; PSADT, PSA doubling time.
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