Muniz Miguel, Childs Daniel S, Andrews Jack, Mahmoud Ahmed M, Park Sean, Sartor Oliver, Kase Adam M, Riaz Irbaz B, Stish Bradley J, Chaudhuri Aadel A, Chauhan Pradeep S, Phillips Ryan, Lucien Fabrice, Orme Jacob J
Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Mayo Clinic, Phoenix, AZ, USA.
Ann Transl Med. 2025 Jun 27;13(3):29. doi: 10.21037/atm-24-187. Epub 2025 Jun 24.
Distant metastasis marks a critical transition in prostate cancer, separating potentially curable from canonically incurable disease. Oligometastatic disease, defined as limited metastases (e.g., less than 3, 5, or 10), can encompass different clinical scenarios, including oligorecurrent disease (characterized by a limited number of metastatic lesions that recur after initial definitive treatment), and has emerged as an intermediate or transitional state. While intensified systemic therapies are increasingly applied to metastatic cases, many patients prefer to delay starting castrating therapies. Metastasis-directed therapy (MDT) is a safe and effective alternative to systemic therapy in a subset of patients with well-defined oligometastatic disease. Recent advances in imaging technologies and emerging treatment paradigms pose clinical challenges for patient risk stratification and optimal treatment selection. Here, we explore two key developments in the field: the influence of advanced imaging on clinical decision-making and the growing role of radiotherapy (RT) in oligometastatic disease management. We explore the landscape of novel biomarkers to estimate micrometastatic disease burden, which eludes imaging, using the concept of "liquid tumor burden" (LTB) measured by blood-based markers like circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and tumor-derived extracellular vesicles (tdEVs). Promising data suggest that LTB assessment may refine patient selection for MDT and systemic treatment. These findings suggest potential for a combined approach of MDT and systemic therapy in oligometastatic prostate cancer (omPC).
远处转移标志着前列腺癌的一个关键转变，将潜在可治愈的疾病与典型的不可治愈疾病区分开来。寡转移疾病定义为转移灶有限（例如，少于3个、5个或10个），可涵盖不同的临床情况，包括寡复发性疾病（其特征是在初始确定性治疗后复发的转移病灶数量有限），并已成为一种中间或过渡状态。虽然强化全身治疗越来越多地应用于转移病例，但许多患者更愿意推迟开始去势治疗。对于一部分具有明确寡转移疾病的患者，转移灶导向治疗（MDT）是全身治疗的一种安全有效的替代方法。成像技术的最新进展和新兴的治疗模式给患者风险分层和最佳治疗选择带来了临床挑战。在此，我们探讨该领域的两个关键进展：先进成像对临床决策的影响以及放疗（RT）在寡转移疾病管理中日益重要的作用。我们利用通过循环肿瘤DNA（ctDNA）、循环肿瘤细胞（CTC）和肿瘤衍生细胞外囊泡（tdEV）等基于血液的标志物测量的“液体肿瘤负荷”（LTB）概念，探索新型生物标志物以估计难以通过成像检测到的微转移疾病负担的情况。有前景的数据表明，LTB评估可能会优化MDT和全身治疗的患者选择。这些发现提示了在寡转移前列腺癌（omPC）中联合应用MDT和全身治疗的潜力。
