Oligometastasis can be described as a state of limited metastatic disease following failed primary treatment or even prostate cancer as it is first diagnosed. Many doctors believe that it is amenable to aggressive local therapy to achieve long-term survival.
In a review designed to explore the role of ablative radiotherapy and surgical management of oligo-metastatic prostate cancer (CaP) researchers performed a systematic review of the literature from November 2003 to November 2013 in the PubMed and EMBASE databases using structured search terms.
In the literature search, they identified 13 cases of oligometastatic CaP managed by surgery. The longest disease-free survival documented was 12 years following pulmonary metastasectomy.
We also found 12 studies using radiotherapy to treat oligometastatic CaP with median follow-up ranging from 6 to 43 months. Local control rates and overall survival at 3 years range from 66 to 90% and from 54 to 92%, respectively. Most patients did not report any significant toxicity.
They concluded thatin the limited current literature oligometastatic CaP may be amenable to more aggressive local ablative therapy to achieve prolonged local control and delay to the need to start androgen deprivation therapy (ADT). There is a larger body of evidence supporting the use of radiotherapy than surgery in this disease state.
However, no direct comparison with ADT is available to suggest an improvement in overall survival. Further studies are required to determine the role of aggressive-targeted local therapy in oligometastatic prostate cancer.
Asia Pac J Clin Oncol. 2014 Aug 25. Epub ahead of print.
doi: 10.1111/ajco.12256; Yao HH, Hong MK, Corcoran NM, Siva S, Foroudi F. Division of Urology, Department of Surgery, The University of Melbourne, Royal Melbourne Hospital, Parkville, Australia.
Joel T. Nowak, M.A., M.S.W.