scholarly journals Recent Advances in the Management of Hormone-Sensitive Oligometastatic Prostate Cancer

2022 ◽  
Vol Volume 14 ◽  
pp. 89-101
Author(s):  
Giulia Marvaso ◽  
Stefania Volpe ◽  
Matteo Pepa ◽  
Mattia Zaffaroni ◽  
Giulia Corrao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Recent Advances ◽  
Oligometastatic Prostate Cancer ◽  
Hormone Sensitive

scholarly journals Multimodal therapy for oligometastatic prostate cancer: results from a single-centre study

2021 ◽  
Vol 9 (4) ◽  
pp. 70-86
Author(s):  
K. M. Nyushko ◽  
V. M. Perepukhov ◽  
B. Ya. Alekseev
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Clinical Practice ◽  
Drug Therapy ◽  
Multimodal Therapy ◽  
Randomized Trials ◽  
Bone Lesions ◽  
Oligometastatic Prostate Cancer ◽  
Study Results ◽  
Hormone Sensitive

Introduction. In recent years, interest in the use of radical prostatectomy (RPE) as one of the components of a multimodal approach in patients with lymphogenous disseminated and metastatic prostate cancer (PCa) has grown significantly. At the same time, the dearth of large randomized trials does not make it possible to use this technique in wide clinical practice outside of clinical trials.Purpose of the study. To evaluate the effectiveness of multimodal therapy using combined chemo-hormonal, surgical and radiation therapy in patients with primary oligometastatic hormone-sensitive PCa.Material and methods. The study included 48 patients with primary oligometastatic prostate cancer who received combination treatment within the internal one-research-center protocol. At the first stage, all patients underwent combined drug therapy with docetaxel (75 mg/m2 intravenously every 3 weeks for 6 courses) and degarelix. Patients who had a decrease in PSA level ≤ 2 ng/ml and registered stabilization of the disease according to radiological examination were treated surgically through RPE with extended pelvic and retroperitoneal lymph node dissection. Radiation therapy was performed only in patients with the presence of bone lesions at a dose of 50-70 Gy to the location of bone metastases in the stage 3 plan of combined multimodal therapy.Results. PCa biochemical relapse was verified in 27 (56.3%) patients during the median follow-up of 10 months. The average time to PSA increase was 9.0 ± 5.7 months (from 1 to 24 months), median — 7 months, Six-month PSA relapse-free survival (PSA-RFS) was 61.2 ± 7.5%; 1-year PSA-RFS — 38.0 ± 8.6%. The average duration before the initiation of hormonal therapy was 12 ± 6.1 months (from 3 to 27 months), median: 10 months. Six-month survival before the drug administration was 72.6 ± 6.8%; twelve-month survival: 40.9 ± 8.7%. About 40% of patients with oligometastatic PCa had no signs of progression and did not receive any other drug therapy for 12 months after completion of protocol treatment.Conclusions. Analysis of the study results demonstrates satisfactory oncological outcomes of the studied treatment option in patients with newly diagnosed oligometastatic hormone-sensitive PCa, as well as a low likelihood of side effects and complications. Nevertheless, it is necessary to continue conducting larger and more structured randomized trials to determine the possibility of applying this therapeutic approach in clinical practice.

scholarly journals A phase II randomized trial of Observation versus stereotactic ablative RadiatIon for OLigometastatic prostate CancEr (ORIOLE).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 116-116
Author(s):  
Phuoc T. Tran ◽  
Ryan Phillips ◽  
William Shi ◽  
Su Jin Lim ◽  
Emmanuel S. Antonarakis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Trial ◽  
Phase Ii ◽  
Cell Receptor ◽  
Circulating Tumor Dna ◽  
Oncologic Outcomes ◽  
Radiation Fields ◽  
Oligometastatic Prostate Cancer ◽  
Hormone Sensitive ◽  
Grade 3

116 Background: Mounting evidence supports metastatic ablation for oligometastatic prostate cancer (OMPC). Importantly, biomarkers to determine patients who benefit most from complete ablation are unknown. We hypothesize that stereotactic ablative radiation (SABR) will improve oncologic outcomes in men with OMPC. Methods: In this phase II randomized trial, men with recurrent hormone-sensitive OMPC (1-3 radiation fields) were stratified by primary management (radiotherapy vs surgery), PSA doubling time, and prior androgen deprivation therapy and randomized 2:1 to SABR or observation (OBS). The primary endpoint was progression at 6 months by PSA (≥ 25% increase and ≥ nadir + 2 ng/mL), conventional imaging (RECIST 1.1 criteria or new lesion on bone scan), or symptomatic decline. Tissue, liquid and imaging correlatives were analyzed as biomarkers. Results: From 5/2016-3/2018, 54 patients were randomized. Progression at six months occurred in 19% of SABR patients and 61% of observation patients [p=0.005]. SABR improved median PFS (not reached vs 5.8 months, HR 0.30, p = 0.0023). Total consolidation of PSMA radiotracer-avid disease decreased the risk of new lesions at six months (16% vs 63%, p = 0.006). No toxicity ≥ grade 3 was observed. T-cell receptor sequencing identified increased clonotypic expansion (p = 0.03) following SABR and correlation between baseline clonality and progression with SABR only. Analysis of circulating tumor DNA (ctDNA) and germline mutations identified a mutation profile that was associated with benefit from SABR. Conclusions: SABR for OMPC improves outcomes and is enhanced by total consolidation of disease identified by PSMA-targeted PET. SABR induces a systemic immune response, and baseline immune phenotype and tumor mutation status may predict the benefit from SABR. These results underline the importance of prospective randomized investigation of the oligometastatic state with integrated imaging and biological correlates. Clinical trial information: NCT02680587.

scholarly journals Metastasis Directed Therapy and/or Systemic Therapy in Hormone-naive Oligometastatic Prostate Cancer Patient: an Emerging Dilemma

2021 ◽  
Vol 1 (1) ◽  
pp. 139-144
Author(s):  
Francesco Cuccia ◽  
Filippo Alongi
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Patient ◽  
Optimal Management ◽  
Micrometastatic Disease ◽  
Local Approach ◽  
Oligometastatic Prostate Cancer ◽  
Hormone Sensitive ◽  
Detrimental Impact ◽  
Transition Scenario

"The hormone-naive oligometastatic prostate cancer is a challenging setting for the radiation oncology community, as it represents a sort of transition scenario potentially suitable for two different approaches: a local ablative treatment alone vs a metastasisdirected treatment with the addition of hormone therapy. The choice to add androgen deprivation therapy in the oligorecurrent hormone-sensitive patient is a matter of debate, given the detrimental impact on quality of life and the number of adverse events. To date, there is no clear agreement on the optimal management of this subset of patients. As some authors highlight the attractiveness of a local approach alone, as well tolerated, easily repeatible and with very limited costs, on the other hand, other authors focus the need to cover the micrometastatic disease, often not detectable, even with the newly available imaging modalities. In this commentary, we briefly summarize the literature data in support of both therapeutic strategies."

scholarly journals Management and treatment options for patients with de novo and recurrent hormone-sensitive oligometastatic prostate cancer

2021 ◽  
Author(s):  
Felix Preisser ◽  
Felix. K.-.H. Chun ◽  
Severine Banek ◽  
Mike Wenzel ◽  
Markus Graefen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
De Novo ◽  
Treatment Options ◽  
Oligometastatic Prostate Cancer ◽  
Hormone Sensitive

scholarly journals Prostate-Specific Membrane Antigen (PSMA) Theranostics for Treatment of Oligometastatic Prostate Cancer

2021 ◽  
Vol 22 (22) ◽  
pp. 12095
Author(s):  
Kristin A. Plichta ◽  
Stephen A. Graves ◽  
John M. Buatti
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Membrane Antigen ◽  
Resistant Disease ◽  
Stage Disease ◽  
Oligometastatic Prostate Cancer ◽  
Hormone Sensitive ◽  
Prostate Cancers ◽  
Castrate Resistant ◽  
Specific Membrane ◽  
Potential Use

Theranostics, a combination of therapy and diagnostics, is a field of personalized medicine involving the use of the same or similar radiopharmaceutical agents for the diagnosis and treatment of patients. Prostate-specific membrane antigen (PSMA) is a promising theranostic target for the treatment of prostate cancers. Diagnostic PSMA radiopharmaceuticals are currently used for staging and diagnosis of prostate cancers, and imaging can predict response to therapeutic PSMA radiopharmaceuticals. While mainly used in the setting of metastatic, castrate-resistant disease, clinical trials are investigating the use of PSMA-based therapy at earlier stages, including in hormone-sensitive or hormone-naïve prostate cancers, and in oligometastatic prostate cancers. This review explores the use of PSMA as a theranostic target and investigates the potential use of PSMA in earlier stage disease, including hormone-sensitive metastatic prostate cancer, and oligometastatic prostate cancer.

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