Current evidence on local therapy in oligometastatic prostate cancer

Purpose of review: Metastatic prostate cancer (PCa) continues to be an invariably fatal condition. While historically, de-novo metastatic PCa was primarily treated with androgen deprivation therapy (ADT) and systemic therapy, there is a growing trend toward incorporating local treatments in the early management of the disease. This is particularly applicable to men with oligometastatic PCa (OMPC), which represents an 'intermediate phase' between localized and disseminated metastatic disease. Local treatment offers an opportunity for disease control before it progresses to a more advanced stage. This review discussed the current evidence for local treatment options for OMPC.

Recent findings: Currently, it has been suggested that men with OMPC may have a more indolent course and, therefore, favorable outcomes may be observed with metastasis-directed therapy (MDT). This review will not address the role of MDT to patients with OMPC but will focus on local treatments of the primary disease. The three main forms of local therapy employed for OMPC are cryotherapy, radiation therapy, and cytoreductive prostatectomy (CRP). Whole gland cryotherapy, either with ADT or with ADT and systemic chemotherapy, has shown some limited promising results. Radiation therapy combined with ADT has also demonstrated improvements in progression-free survival in clinical trials (primarily STAMPEDE Arm G and HORRAD). CRP often combined with ADT has emerged as a potential strategy for managing OMPC, with promising findings primarily from retrospective studies. Currently, several randomized controlled trials are underway to further investigate the role of CRP in the oligometastatic setting.

Summary: OMPC has become a unique category of disease with specific therapeutic implications. Lack of robust clinical data renders treatment selection controversial. Further studies with long follow up are necessary to identify men with oligometastatic disease who will benefit from local treatment.