Management of oligometastatic prostate cancer

This study aimed to review the current management strategies for oligometastatic prostate cancer (omPCa), focusing on their clinical implications.

A narrative review method was adopted, synthesizing the leading evidence on issues associated with omPCa management.

Androgen deprivation therapy (ADT) remains fundamental in omPCa. Combination with androgen receptor signalling inhibitors (ARSI) and/or chemotherapy were found to improve survival. Triplet therapy can be considered a new standard of care; however, no direct comparison with ADT + ARSI doublet exists. There is a trend towards patient-tailored decisions for optimal systemic treatment, mainly based on clinical data such as disease volume. For low-volume omPCa patients, local radiotherapy showed modest survival improvement and should be considered as a part of multimodality treatment. Cytoreductive radical prostatectomy is promising but remains investigational. Metastases-directed therapy (MDT) can be used to delay the initiation of ADT in metachronous omPCa patients. Although promising, insufficient data exist to conclusively prove that MDT benefits major oncologic outcomes in the context of treatment intensification. In scenarios where MDT could preclude therapies supported by high-quality evidence, the choice of the best systemic treatment should precede MDT.

The increased detection of omPCa due to advanced imaging necessitates an evolving treatment paradigm, encompassing systemic therapies, local treatments, and MDT. Current treatments largely rely on clinical disease burden and timing. We anticipate that diagnostic advancements and ongoing research will pave the way for personalized treatment options in omPCa management.