Bernard Brandon, Gershman Boris, Karnes R Jeffrey, Sweeney Christopher J, Vapiwala Neha
From the Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Mayo Clinic, Rochester, MN; University of Pennsylvania, Philadelphia, PA.
Am Soc Clin Oncol Educ Book. 2016;35:119-29. doi: 10.1200/EDBK_159241.
Oligometastatic prostate cancer has increasingly been recognized as a unique clinical state with therapeutic implications. It has been proposed that patients with oligometastases may have a more indolent course and that outcome may be further improved with metastasis-directed local ablative therapy. In addition, there are differing schools of thoughts regarding whether oligometastases represent isolated lesions-where targeted therapy may render a patient disease free-or whether they coexist with micrometastases, where targeted therapy in addition to systemic therapy is required for maximal clinical impact. As such, the approach to the patient with oligometastatic prostate cancer requires multidisciplinary consideration, with surgery, radiotherapy, and systemic therapy potentially of benefit either singularly or in combination. Indeed, mounting evidence suggests durable disease-free intervals and, in some cases, possibly cure, may be achieved with such a multimodal strategy. However, selecting patients that may benefit most from treatment of oligometastases is an ongoing challenge. Moreover, with the advent of new, highly sensitive imaging technologies, the spectrum based on CT of the abdomen and pelvis and technetium bone scan of localized to oligometastatic to widespread disease has become increasingly blurred. As such, new MRI- and PET-based modalities require validation. As some clinical guidelines advise against routine prostate-specific antigen screening, the possibility of more men presenting with locally advanced or de novo oligometastatic prostate cancer exists; thus, knowing how best to treat these patients may become more relevant at a population level. Ultimately, the arrival of prospective clinical data and better understanding of biology will hopefully further inform how best to treat men with this disease.
寡转移前列腺癌越来越被认为是一种具有治疗意义的独特临床状态。有人提出，寡转移患者的病程可能较为惰性，并且通过转移灶定向局部消融治疗可能进一步改善预后。此外，关于寡转移是代表孤立病灶（靶向治疗可能使患者无病）还是与微转移共存（为达到最大临床效果除全身治疗外还需要靶向治疗）存在不同的观点。因此，对于寡转移前列腺癌患者的治疗方法需要多学科考虑，手术、放疗和全身治疗单独或联合使用可能有益。确实，越来越多的证据表明，采用这种多模式策略可以实现持久的无病间期，在某些情况下甚至可能治愈。然而，选择可能从寡转移治疗中获益最大的患者仍然是一项持续的挑战。此外，随着新的高灵敏度成像技术的出现，基于腹部和盆腔CT以及锝骨扫描的从局限性到寡转移再到广泛疾病的范围越来越模糊不清。因此，基于MRI和PET的新方法需要验证。由于一些临床指南建议不进行常规前列腺特异性抗原筛查，更多男性出现局部晚期或新发寡转移前列腺癌的可能性存在；因此，了解如何最好地治疗这些患者在人群层面可能变得更加重要。最终，前瞻性临床数据的出现以及对生物学的更好理解有望进一步指导如何最好地治疗患有这种疾病的男性。
