Oligometastatic prostate cancer: Reality or figment of imagination?

Abstract

The term “oligometastatic prostate cancer” refers to a heterogeneous group of disease states currently defined solely on the basis of clinical features. Oligorecurrent disease, de novo oligometastases, and oligoprogressive disease likely have unique biologic underpinnings and natural histories. Evidence suggesting the existence of a subset of patients who harbor prostate cancer with limited metastatic potential currently includes disparate and overwhelmingly retrospective reports. Nevertheless, emerging prospective data have corroborated the “better‐than‐expected,” retrospectively observed outcomes, particularly in the setting of oligorecurrent prostate cancer. Improved functional imaging with prostate‐specific membrane antigen‐targeted strategies may enhance the identification of patients with oligometastatic prostate cancer in the short term. In the long term, refinement of the oligometastatic case definition likely will require biologic risk‐stratification schemes. To determine optimal treatment strategies and identify patients most likely to benefit from metastasis‐directed therapy, future efforts should focus on conducting high‐quality, prospective trials with much‐needed molecular correlative studies.

Hyperpolarized 13C-pyruvate MRI detects real-time metabolic flux in prostate cancer metastases to bone and liver: a clinical feasibility study

“…These preliminary results highlight the future need to metabolically characterize lymphadenopathy using HP 13 Cpyruvate MRI, as management of nodal disease could be essential in the realm of biochemically recurrent and oligometastatic PCa [44][45][46][47]. For these cohorts of patients, opportunities for curative treatment are more available, and clinical outcomes are generally better than those with bone involvement and thus higher disease burden.…”

Prostate-specific Membrane Antigen Positron Emission Tomography–detected Oligorecurrent Prostate Cancer Treated with Metastases-directed Radiotherapy: Role of Addition and Duration of Androgen Deprivation

“…The definition of oligometastatic PCa eligible for metastases-directed treatment (MDT) varies [4,5] and is currently clinically based, although evidence for a biological oligometastatic status is emerging [6]. While an imaging-based cutoff of five or fewer distal metastases is frequently used, a greater number of lesions isolated to a single organ could also be regarded as a separate form of oligometastatic disease [7,8].…”

The Role of Magnetic Resonance Imaging in (Future) Cancer Staging

“…Either way, highly sensitive detection of small lymph node metastases is urgently needed. If realized, it can be possible to catch the disease at an early stage of metastatic involvement, so-called oligometastatic disease (eg, in prostate cancer 44 – 46 ). If lymphatic spread has only just begun, an early and accurate, targeted, image-guided focal treatment of the first metastases could delay the course of the disease, or perhaps even still cure the patient.…”