Department of Clinical Oncology, Royal Marsden Hospital NHS Foundation Trust, Surrey, UK; Institute of Cancer Research, Surrey, UK.
Department of Clinical Oncology, Royal Marsden Hospital NHS Foundation Trust, Surrey, UK.
Ann Palliat Med. 2021 May;10(5):5969-5987. doi: 10.21037/apm-20-1215. Epub 2021 Mar 15.
There has been growing interest in oligometastatic prostate cancer (OMPC) with a mounting body of evidence to suggest that it is a distinct disease state, both biologically and prognostically, when compared to polymetastatic prostate cancer. Three subgroups have been recognised; de novo synchronous, metachronous/oligorecurrent and oligoprogressive disease. The belief that patients with OMPC can be treated more aggressively to improve survival is transforming patient care. Identifying these patients poses the first challenge, and we explore the imaging modalities currently utilised and those that are promising. For patients with de novo synchronous OMPC, both early systemic treatment in addition to androgen deprivation therapy (ADT) and radiotherapy to the prostate increase overall survival (OS), and both are increasingly being integrated into routine clinical practice. Metastasis-directed therapy (MDT) has predominantly been delivered using stereotactic body radiotherapy (SBRT) in prostate cancer and studies have shown SBRT is well-tolerated, provides excellent local control and can be used to delay ADT in the metachronous setting. We discuss the current management strategies in OMPC, review the evidence supporting the use of SBRT and outline ongoing trials.
对于寡转移前列腺癌（OMPC）的研究兴趣日益浓厚，越来越多的证据表明，与多转移前列腺癌相比，OMPC 在生物学和预后方面都是一种独特的疾病状态。目前已经识别出三个亚组：新发同步、异时/寡复发和寡进展性疾病。人们相信，OMPC 患者可以接受更积极的治疗来提高生存率，这正在改变患者的治疗方式。识别这些患者是面临的第一个挑战，我们探讨了目前使用的影像学方法和有前途的方法。对于新发同步 OMPC 患者，早期全身治疗联合雄激素剥夺治疗（ADT）和前列腺放射治疗可提高总生存率（OS），这两种治疗方法都越来越多地被纳入常规临床实践。转移灶定向治疗（MDT）主要采用立体定向体放射治疗（SBRT）治疗前列腺癌，研究表明 SBRT 耐受性良好，提供了极好的局部控制效果，并可用于延迟异时性 ADT 的使用。我们讨论了 OMPC 的当前管理策略，回顾了支持 SBRT 使用的证据，并概述了正在进行的试验。
