Gargi Kothari1,2, Piet Ost3, Patrick Cheung4, Pierre Blanchard5, Alison C Tree6, Nicholas J van As6, Simon S Lo7, Drew Moghanaki8, Andrew Loblaw4, Shankar Siva9,10. 1. Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia. 2. Peter MacCallum Cancer Center, Melbourne, Victoria, Australia. 3. Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. 4. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Ave TG 260, Toronto, ON, M4N 3M5, Canada. 5. Gustave-Roussy, Radiotherapy Department, Paris-Saclay University, 114 Rue Edouard Vaillant, F-94800, Villejuif, France. 6. Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK. 7. Department of Radiation Oncology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, 98195, USA. 8. Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA. 9. Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Peter MacCallum Cancer Center, Melbourne, Victoria, 3000, Australia. Shankar.Siva@petermac.org. 10. Peter MacCallum Cancer Center, Melbourne, Victoria, Australia. Shankar.Siva@petermac.org.
Abstract
PURPOSE OF REVIEW: Systemic therapy for patients with hormone-sensitive oligometastatic prostate cancer is non-curative and associated with toxicities. Meanwhile, this population presents unique clinical opportunities to improve outcomes, including the demonstrated benefits of radiotherapy to the primary tumor or oligometastatic sites. RECENT FINDINGS: Recently published randomized studies have demonstrated benefits with the addition of radiotherapy to the primary disease or metastatic lesions in patients with synchronous or metachronous disease. The introduction of novel PET imaging has improved the sensitivity and specificity for detecting metastatic disease and provides an opportunity to better select patients who will benefit from local therapy. The data presented in this review supports revisiting practice guidelines for patients with hormone-sensitive metastatic prostate cancer, particularly in relation to the role of radiotherapy to the primary tumor and sites of oligometastatic disease. Future trials will aim to further establish the role of metastasis-directed therapies in metachronous, synchronous, and castrate-resistant disease.
PURPOSE OF REVIEW: Systemic therapy for patients with hormone-sensitive oligometastatic prostate cancer is non-curative and associated with toxicities. Meanwhile, this population presents unique clinical opportunities to improve outcomes, including the demonstrated benefits of radiotherapy to the primary tumor or oligometastatic sites. RECENT FINDINGS: Recently published randomized studies have demonstrated benefits with the addition of radiotherapy to the primary disease or metastatic lesions in patients with synchronous or metachronous disease. The introduction of novel PET imaging has improved the sensitivity and specificity for detecting metastatic disease and provides an opportunity to better select patients who will benefit from local therapy. The data presented in this review supports revisiting practice guidelines for patients with hormone-sensitive metastatic prostate cancer, particularly in relation to the role of radiotherapy to the primary tumor and sites of oligometastatic disease. Future trials will aim to further establish the role of metastasis-directed therapies in metachronous, synchronous, and castrate-resistant disease.
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