Oligometastases in prostate cancer: Ablative treatment

Abstract

Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy (SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer (PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist (e.g., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.

Keywords: Oligometastases; Metastasis-directed therapy; Stereotactic body radiation therapy; Stereotactic ablative radiotherapy; Prostate cancer

Core tip: The hypothesis that oligometastatic disease may be cured with local eradication therapies has led to the growing use in prostate cancer (PCa) of treatments targeted to metastasis, including stereotactic body radiation therapy (SBRT). Such therapy intends to complement, replace or delay the introduction of systemic therapy. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa, and examines aspects where gaps in knowledge persist, e.g., optimum schemes, response assessment, and identification and diagnosis of oligometastatic patients.