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Treatment of Oligometastatic Hormone-Sensitive Prostate Cancer: A Comprehensive Review

구교철|Prokar Dasgupta
연세대학교의과대학 (Yonsei University College of Medicine)|2018.07|Yonsei Medical Journal|제59권 제5호|pp. 567-579|DOI 10.3349/ymj.2018.59.5.567

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참고문헌

키워드

hormonesprostate cancerradiotherapyNeoplasm metastasisprostatectomyoligometastasis
주제분류의학일반

초록

With advancements in diagnostic techniques, including molecular and clinical imaging, that directly target cancer cells, oligometastaticprostate cancer (PCa) is being diagnosed in patients who were, in the past, considered to have localized disease. Withaccumulating evidence, there has been a paradigm shift in considering aggressive treatments targeted at both the primary tumorand metastatic lesions in an aim to avoid and delay the need for palliative treatments and, ultimately, to achieve survival benefits. However, many questions still remain unanswered regarding the understanding of oligometastatic PCa, from its definition to optimaltreatment strategies for each individual. Limited retrospective studies have suggested that interventions, including localand/or metastasis-directed therapy using surgery and radiation therapy (RT), can improve survival outcomes with minimal riskof adverse effects. Such treatments have been shown to decrease the risks of subsequent palliative interventions and to delay thestart of androgen-deprivation therapy. Nevertheless, available data are insufficient to draw a reliable conclusion regarding theireffect on quality of life measures and overall survival. This comprehensive review overviews data from contemporary literaturethat have investigated treatments, including surgery and RT, for patients with oligometastatic PCa, namely pelvic lymph nodepositive disease and limited distant metastases, and summarizes ongoing trials that are evaluating the feasibility of aggressivemultimodal treatments.

Abstract

With advancements in diagnostic techniques, including molecular and clinical imaging, that directly target cancer cells, oligometastaticprostate cancer (PCa) is being diagnosed in patients who were, in the past, considered to have localized disease. Withaccumulating evidence, there has been a paradigm shift in considering aggressive treatments targeted at both the primary tumorand metastatic lesions in an aim to avoid and delay the need for palliative treatments and, ultimately, to achieve survival benefits. However, many questions still remain unanswered regarding the understanding of oligometastatic PCa, from its definition to optimaltreatment strategies for each individual. Limited retrospective studies have suggested that interventions, including localand/or metastasis-directed therapy using surgery and radiation therapy (RT), can improve survival outcomes with minimal riskof adverse effects. Such treatments have been shown to decrease the risks of subsequent palliative interventions and to delay thestart of androgen-deprivation therapy. Nevertheless, available data are insufficient to draw a reliable conclusion regarding theireffect on quality of life measures and overall survival. This comprehensive review overviews data from contemporary literaturethat have investigated treatments, including surgery and RT, for patients with oligometastatic PCa, namely pelvic lymph nodepositive disease and limited distant metastases, and summarizes ongoing trials that are evaluating the feasibility of aggressivemultimodal treatments.

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