PCa17: Treatment of oligometastatic prostate cancer

17 September 2017

In men with oligometastatic prostate cancer, radical prostatectomy (RP) is linked to higher survival rates compared with other therapies, and patients also benefit from less palliative treatment. 

“Local therapy (radical prostatectomy and radiation therapy) seem safe and reduce the need of palliative treatment,” said Prof. M. Brausi (IT) during a session at the EAU Update on Prostate Cancer (PCa17) in Vienna.

Brausi gave an overview on the treatment of oligometastatic prostate cancer wherein he assessed the efficacy of various treatment approaches.

“Oligometastatic disease is an intermediate state of tumour spread with limited metastatic capacity. The loco-regional has better prognosis than systemic spread.  The implication is that some patients in this state could be cured with definitive directed therapies,” explained Brausi. He cited the SEER Database which showed overall survival outcomes with radical prostatectomy (RP), radiation therapy (RT) and hormone therapy (HP).

“Men treated with RP had a 62% decreased risk of CSM (cancer-specific mortality) and men treated with BC had a 32% decreased risk,” he said. “RP was associated with decreased CSM in all metastatic stages while brachytherapy improved CSM in M1c disease.”

Other factors independently linked to CSM were GS 8, cT4, PSA less than 20ng/ml, cN1, M1b (distant metastasis of bone) or M1c (distant metastasis of other non-LN sites +/_bone disease) and year of diagnosis.

Regarding cytoreductive RP in PCa patients with low-volume skeletal metastases, among the inclusion criteria are the following:

  • Locally resectable prostate cancer
  • < 3 hot spots in bone scan
  • Pelvic lymph node metastases < 3cm
  • No retroperitoneal lymph node metastases
  • No visceral metastases

On treatment strategies, Brausi mentioned offering neoadjuvant androgen deprivation (LHRH analogues) for six months,  in patients with PSA less than 0.4 ng/ml an option of extended RP and extended pelvic lymphadenectomy, and adjuvant ADT for two years.

“Oligometastatic prostate cancer includes a spectrum of biologies. Some oligometastatic cancer progress slowlt and can be a separate entity,” said Brausi as he reiterated that RP is associated with significant survival and that cytoreductive RP might be an option in men with good prognosis following neoadjuvant ADT.

He also ended his lecture with a cautionary message: “Aggressive treatment of oligometastatic PCa should be considered only in the setting of prospective trials.”