Top Line: The goals of metastasis-directed therapy (MDT) for oligometastatic prostate cancer are to reduce the risk of progression at existing sites of disease as well as delay progression at distant sites.
The Study: We’ve seen the overall disease outcome benefits of MDT, but how exactly does it influence patterns of subsequent disease progression? In this large, retrospective database from Hopkins and Mayo, 258 men with 474 metastases from oligometastatic (usually ≤5 sites) castration-sensitive prostate cancer received MDT. Most men had only a single site of metastatic disease, and roughly two-thirds of targets were bone mets with the rest being mostly nodal mets. There were three general patterns of progression: those with long-term disease control and no progression for > 18 months (class I, 41%), those with oligoprogression at ≤3 sites (class II, 36%), and those with polymetastatic progression (class III, 23%). With respect to the sites of progression, most men with bone mets progressed in the bone (87%), and most men with nodal mets progressed in other nodes (65%).TBL: Three-quarters of men with oligometastatic prostate cancer achieve long-term control or limited disease progression with metastasis-directed therapy. | Deek, Int J Radiat Oncol Biol Phys 2020