Scharl S, Hadaschik B, Wiegel T, Thomas C
Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie, Universitätsklinikum Essen, Essen, Deutschland.
Urologe A. 2021 Dec;60(12):1527-1533. doi: 10.1007/s00120-021-01643-0. Epub 2021 Nov 26.
Multimodal treatment concepts are gaining in importance in the treatment of prostate cancer patients with primary oligometastatic disease. Data from randomized studies show that survival advantages can be achieved in this patient collective by the combination of local and systemic treatment compared to systemic treatment alone.
To analyze the available data on therapeutic approaches for oligometastatic prostate cancer.
Summary and discussion of current studies on systemic and local treatment of de novo oligometastatic prostate cancer.
Systemic treatment continues to be the standard of care in the oligometastatic stage of prostate cancer. Furthermore, irradiation of the prostate is recommended for patients with a low metastasis burden after this led to an extension of the overall survival in a randomized phase III study. Large case series suggest that radical prostatectomy can also improve oncological endpoints. The results of prospective phase II studies on metachronous metastatic disease provide evidence that local ablative radiotherapy of individual metastases can improve progression-free survival; however, the value of this approach in de novo metastatic disease is just as unclear as that of a triple treatment combination consisting of local and extended systemic treatment.
In addition to systemic treatment, irradiation of the prostate is a new standard of care for the oligometastatic stage ("low tumour burden").
多模式治疗理念在原发性寡转移前列腺癌患者的治疗中日益重要。随机研究数据表明，与单纯全身治疗相比，局部和全身治疗联合应用可使该类患者群体获得生存优势。
分析寡转移前列腺癌治疗方法的现有数据。
总结并讨论目前关于初发性寡转移前列腺癌全身和局部治疗的研究。
全身治疗仍是前列腺癌寡转移阶段的标准治疗方法。此外，对于转移负担较低的患者，推荐进行前列腺照射，因为在一项随机III期研究中，这可延长总生存期。大型病例系列研究表明，根治性前列腺切除术也可改善肿瘤学终点。关于异时性转移疾病的前瞻性II期研究结果表明，对单个转移灶进行局部消融放疗可改善无进展生存期；然而，这种方法在初发性转移疾病中的价值与局部和扩大全身治疗组成的三联治疗组合的价值一样不明确。
除全身治疗外，前列腺照射是寡转移阶段（“低肿瘤负担”）的新的标准治疗方法。
