Abstract
To evaluate the outcomes of total eradication therapy (TET), designed to eradicate all sites of visible cancer and micrometastases, in men with newly diagnosed oligometastatic prostate cancer (OMPCa). Men with ≤ 5 sites of metastases were enrolled in a prospective registry study, underwent neoadjuvant chemohormonal therapy, followed by radical prostatectomy, adjuvant radiation (RT) to prostate bed/pelvis, stereotactic body radiation therapy (SBRT) to oligometastases, and adjuvant hormonal therapy (HT). When possible, the prostate-specific membrane antigen targeted 18F-DCFPyL PET/CT (18F-DCFPyL) scan was obtained, and abiraterone was added to neoadjuvant HT. Twelve men, median 55 years, ECOG 0, median PSA 14.7 ng/dL, clinical stages M0—1/12 (8%), M1a—3/12 (25%) and M1b—8/12 (67%), were treated. 18F-DCFPyL scan was utilized in 58% of cases. Therapies included prostatectomy 12/12 (100%), neoadjuvant [docetaxel 11/12 (92%), LHRH agonist 12/12 (100%), abiraterone + prednisone 6/12 (50%)], adjuvant radiation [RT 2/12 (17%), RT + SBRT 4/12 (33%), SBRT 6/12 (50%)], and LHRH agonist 12/12 (100%)]. 2/5 (40%) initial patients developed neutropenic fever (NF), while 0/6 (0%) subsequent patients given modified docetaxel dosing developed NF. Otherwise, TET resulted in no additive toxicities. Median follow-up was 48.8 months. Overall survival was 12/12 (100%). 1-, 2-, and 3-year undetectable PSA’s were 12/12 (100%), 10/12 (83%) and 8/12 (67%), respectively. Median time to biochemical recurrence was not reached. The outcomes suggest TET in men with newly diagnosed OMPCa is safe, does not appear to cause additive toxicities, and may result in an extended interval of undetectable PSA.
Highlights
In 1995, the term oligometastases (OM) was coined to describe a disease state existing between localized and widespread systemic disease [1], possibly biologically distinct and more amenable to therapy
Men newly diagnosed with prostate cancer (PCa) and distant metastases have an overall 5 year survival rate of 31% [2]
There is an increasing appreciation that men with metastatic disease should be further classified by disease burden, either oligometastatic or low tumor burden versus polymetastatic or high tumor burden, and that different treatment strategies should be developed for these clinical states
Summary
In 1995, the term oligometastases (OM) was coined to describe a disease state existing between localized and widespread systemic disease [1], possibly biologically distinct and more amenable to therapy. Despite the absence of both a consensus definition and any specific diagnostic test for OM, patients with newly diagnosed prostate cancer (PCa) and limited metastases are being treated by targeting the primary and metastatic sites, if not to cure OM cancer, at least to possibly turn back the clock of the natural course of the disease. In OM, or low-burden metastatic PCa, randomized studies support radiation to the primary site [3], metastasis directed therapy (MDT) [4, 5] and systemic therapies, including the antiandrogen abiraterone acetate, which when added to ADT further inhibits androgen synthesis [6, 7] and taxotere [8, 9]. While all the above studies have shown improved outcomes, multimodal therapy may further improve outcomes by targeting all visible disease as well as micrometastases
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
