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Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations

Nature Reviews Urology volume 14, pages 15–25 (2017)Cite this article

Subjects

Key Points

  • Cancers presenting in the oligometastatic state likely include a spectrum of biologies

  • Some oligometastatic lesions quickly progress to widespread metastases, others metastasize gradually, and others lack the capacity for widespread progression, such that oligometastatic disease represents their maximum potential for progression

  • Preliminary genomic data support a molecular basis underlying phenotypic variability; however, for now, oligometastatic prostate cancer can be reasonably defined by up to five extrapelvic lesions

  • Local consolidative therapies, such as prostatectomy and radiotherapy, seem safe to perform in the metastatic setting and seem to reduce the need for palliative treatment; the effect of local therapy on survival outcomes cannot be determined conclusively using available data

  • Metastasis-directed approaches, such as stereotactic body radiotherapy, are associated with minimal toxicity and provide excellent local control; however, current data are insufficient for determining their effect on oncological outcomes

  • Aggressive treatment of oligometastatic prostate cancer should be considered only in the setting of prospective clinical trials or registries, with the patient informed of the limited evidence of benefit from such approaches

Abstract

The oligometastatic state has been proposed as an intermediate stage of cancer spread between localized disease and widespread metastases. With improvements in diagnostic modalities such as functional imaging, oligometastatic prostate cancer is being diagnosed with greater frequency than ever before. Furthermore, the paradigm for treatment of advanced prostate cancers is shifting toward a more aggressive approach. Many questions surround the understanding of the process and consequences of oligometastasis, meaning that the contemporary literature offers a wide variety of definitions of oligometastatic prostate cancer. Until genomic data exist to provide a biological component to the definition of oligometastatic disease, a clinical diagnosis made on the basis of up to five extrapelvic lesions is reasonable for use. Retrospective studies suggest that interventions such as radical prostatectomy and local or metastasis-directed radiotherapy can be performed in the metastatic setting with minimal risk of toxic effects. These therapies seem to decrease the need for subsequent palliative interventions, but insufficient data are available to draw reliable conclusions regarding their effect on survival. Thus, a protocol for clinicians to manage the patient presenting with oligometastatic prostate cancer would be a useful clinical tool.

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Figure 1: Recurrent prostate cancer detected with PSMA-targeted 18F-DCFPyL PET–CT.
Figure 2: Schema for the phase II Randomized Observation versus Stereotactic Ablative RadiatIon for OLigometastatic Prostate CancEr (ORIOLE) trial.

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Acknowledgements

A.E.R. is supported by a DOD PRTA award (W81XWH− 13 − 1 − 0445) as well as a PCF Young Investigator Award and Patrick C. Walsh Investigator Grant. P. T. Tran was funded by the Motta and Nesbitt Families,the DoD (W81XWH- 11-1-0272), a Kimmel Translational Science Award (SKF-13-021), an ACS Scholar award (122688-RSG-12- 196-01-TBG), the NIH (R01CA166348 & 1U01CA183031) and a Movember-PCF Challenge Award. E.M.S. is supported by NIH U01CA196390−01.

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  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Marburg 134, Baltimore, 21287, MD, USA

    Jeffrey J. Tosoian, Michael A. Gorin, Ashley E. Ross & Kenneth J. Pienta

  2. Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Weinberg Building, Ground Floor Room 1389A, Baltimore, 21231, MD, USA

    Phuoc T. Tran

  3. Department of Urology, Northwestern University, 303 East Chicago Avenue, Tarry Building 16–713, Chicago, 60611, Illinois, USA

    Edward M. Schaeffer

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Tosoian, J., Gorin, M., Ross, A. et al. Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations. Nat Rev Urol 14, 15–25 (2017). https://doi.org/10.1038/nrurol.2016.175

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