International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: prostateIs there a favorable subset of patients with prostate cancer who develop oligometastases?
Introduction
The widely accepted treatment for patients with metastatic prostate cancer is hormonal therapy and palliative radiotherapy (RT) 1, 2. However, some authors have suggested that patients with a finite number of metastases (oligometastases) may experience improved survival after surgery or aggressive treatment using radiosurgery or high-dose radiation techniques that have the potential for sterilizing such disease 3, 4, 5, 6. It is our hypothesis that the prognosis of the disease may vary as a function of the number of metastatic lesions and, if the number of lesions is small, aggressive high-dose, conformal RT to sterilize these lesions may result in prolonged survival (5). Recent reports on the role of radiosurgery for patients who presented with recurrent neoplastic involvement of the spinal column have proved that it is both feasible and safe to deliver radiosurgery treatment to such spinal lesions, and the results have been both impressive and encouraging 7, 8, 9.
The objective of this retrospective study was to look at the patterns of metastatic disease that develop after treatment of localized disease with RT in our pool of prostate cancer patients. We were particularly interested in the disease behavior in patients with a small number of metastatic lesions and in their overall survival. Toward this end, we sought to determine whether there was a threshold in the number of metastatic lesions that may affect patient outcome.
Section snippets
Methods and materials
Of the patients treated for prostate cancer in our department at the University of Rochester Medical Center between January 1970 and November 1990, 369 men met our study's eligibility criteria (histology proven cancer, Stage T1–T3aN0-NXM0). Pretreatment evaluation with CT staging and Gleason scores was performed on most patients. Serum PSA levels were available for a limited number of patients. All patients were treated with RT using a four-field box technique or two lateral fields with arcs.
Results
The mean age of the patients was 70.3 years (range 50.7–99). The overall survival rate for all patients (n = 369) was 75% and 45% at 5 and 10 years, respectively (Fig. 1). The disease-specific survival rate (n = 369), calculated by censoring the patients dying of other causes, was 95% and 83% at 5 and 10 years, respectively (Fig. 1). In total, 74 patients (20%) developed metastases to one or more organs; in each case, the first metastasis to develop was in the bone. Fifty-seven patients
Discussion
To date, the existence of a clinically significant state owing to oligometastases has been evidenced by only a few studies 3, 4. These studies have made particular reference to the existence of oligometastases in carcinoma of the lung, colorectal cancers, germ cell tumors, and sarcomas 3, 4, 5, 12. Prostate cancer, which has a predilection for the spread of the disease to the bone, has not been discussed with particular reference to such a state 12, 13, 14, 15. Metastatic disease of the
Conclusion
The development of metastatic lesions in prostate cancer patients is generally associated with a poor prognosis; however, a select group of patients with oligometastasis (those with ≤5 metastatic lesions) has a significantly superior initial survival compared with those patients who develop >5 lesions. This subgroup of patients represents 40.5% of all men with metastatic disease. In these patients, therefore, it may be worth considering aggressive local treatment of metastatic lesions, because
Acknowledgements
The authors thank Dr. Walter O'Dell and Amy Huser for their editorial assistance in the preparation of the manuscript.
References (23)
- et al.
Radiation therapy for treatment of locally advanced and metastatic prostate cancer
Hematol Oncol Clin North Am
(2001) - et al.
Geographical and temporal patterns of incident and mortality from prostate cancer
Urology
(1995) - et al.
Metastatic patterns of prostate cancerAn autopsy study of 1,589 patients
Hum Pathol
(2000) - et al.
Chemotherapy for prostate cancer
Urology
(2002) - et al.
Total bone uptake in management of carcinoma prostate
J Urol
(1987) - et al.
Three dimensional conformal radiation therapy in locally advanced carcinoma of the prostatePreliminary results of a phase I dose escalation study
Int J Radiat Oncol Biol Phys
(1994) - et al.
A multi-institutional experience with stereotactic radiosurgery for solitary brain metastases
Int J Radiat Oncol Biol Phys
(1994) - et al.
Radiotherapy in prostate cancerImprovements in an effective treatment and future prospects of further gains
J S C Med Assoc
(2000) - et al.
Oligometastases
J Clin Oncol
(1995) - et al.
The management of non-small-cell lung cancer with oligometastases
Chest Surg Clin North Am
(2001)
Cited by (196)
Prostate cancer treatment – China's perspective
2022, Cancer LettersSurgery for oligometastatic prostate cancer: Where are we going?
2021, Actas Urologicas Espanolas