Table 11. Oligometastatic prostate cancer.
| 1st Author, Year [Ref] | Strength of evidence-based on study design / endpoints | Prospective (P) / Retrospective (R) | Sample size | Definition-Oligometa stases | Therapy | Endpoints | Conclusion |
|---|---|---|---|---|---|---|---|
| James, 2014 [137] | 1ii /A | P | 917 | N/A – newly diagnosed M1 | LT ADT | FFS- 11 mths. 2yr FFS- 29%. MOS- 42 mth. 2yr OS- 72%. | Survival disappointing in M1 disease started only on LT ADT, despite active treatments available at first ADT failure. Spend most of their time in CR relapse. |
| Singh, 2004 [149] | 3iii/A | R | 30 | ≤5 met lesions | External RT | 5- and 10yr OS- 73% and 36% in OM, as compared to 45% and 18% in those with > 5 met lesions | Findings suggest early detection and aggressive treatment is worth testing to improve long-term survival |
| Engel, 2010 [101] | 3iii /A | R | 938 | +LNs | +/− RP | 5yr- and 10yr OS- 84% and 64% with completed RP, and 60% and 28%, with aborted RP. PCa-specific survival at 5- and 10-yrs- 95% and 86%, with completed RP and was 70% and 40%, with aborted RP | Abandonment of RP in men with positive LNs may not be appropriate |
| Tabata, 2012 [148] | 3iii/A | R | 35 | <6 bone mets on bone scan, each site less than 50% the size of a vertebral body | RT | 3yr OS- 77%; 14/16 (87%) of pats who had pain were improved 1 mth after RT; median duration of pain control 12 month | RT for bone OM in PCa was effective for long-term pain relief |
| Schick, 2013 [141] | 3iii /A | R | 50 | 1–4 mets, synchronous or metachronous | Mets- ADT and HDRT | 3yr biochemical relapse-free survival (bRFS), clinical failure-free survival, and OS- 54.5, 58.6, and 92% | OM may be treated w short ADT and HDRT to the met regions. High dose improves bRFS. May prolong failure-free interval between 2 consecutive ADT courses. |
| Ponti, 2014 [143] | 3iii/A | R | 16 | Distant relapse in a limited number of regions, ≤5 mets | SBRT +/− HT | Local control, biochemical PFS, OS, toxicity. OS at 29 mths 95% Distant relapse in a limited number of regions, ≤5 mets | SBRT safe, effective, minimally invasive in limited LN recurrence in OMPCa |
| Jereczek-Fossa, 2014 [147] | 3iii/A | R | 69 | Single abdominal LN recurrence | SBRT | 3-yr in-field PFS, PFS, OS- 64%, 11.7%, and 50% | SBRT is feasible for single abdominal LN recurrence, offering excellent in-field tumor control. |
| Cadeddu, 1997 [132] | 3iii /B | R | 38 | +LN: pelvic lymph adenopathy | PLND +/− RP | PCa-specific survival at 5- and 10-yrs- (93% and 56% in the PLND/RP group and 58% and 34% in the PLND group | RP, as compared to conservative therapy, may prolong survival |
| Ahmed, 2013 [145] | 3iii/B | R | 17 | ≤5 met lesions | SBRT | Local control-100% at 6mo; cancer specific survival (CSS)-6- and 12mo-100%; freedom from distant progression (FFDP)- 6- and 12mo- 74%, 40% | Excellent LC with SBRT for OM PCa; over 50% patients achieved undetectable PSA after SBRT |
| Ost, 2014 [142] | 3iii /B | R | 80 | Metachronous mets | Mets- ADT, AS, or MDT | Median PCSS- 6.6 yrs. | Longer PSA DT, involvement of nodes or axial skeleton and lower # mets assoc w improved PCSS. |
| Decaestecker, 2014 [144] | 3iii/B | R | 50 | ≤3 metachronous asymptomatic mets | SBRT (2 RT schedules used) +/− HT | Median PFS- 19mo; median ADT-FS- 25 month; 2-, 5yr PCSS-96%, 90% | Repeated SBRT for OM PCa postpones palliative ADT |
| Berkovic, 2013 [146] | 3iii/Di | R | 24 | Biochemical recurrence after curative treatment to primary (RP, RT, or both), then ≤3 synchronous asymptomatic mets | SBRT | Androgen deprivation therapy-free survival (ADT-FS)- 1-, 2yr-82%, 54%; clinical progression free survival- 1-, 2yr- 72% and 42% | Repeated salvage SBRT feasible, well tolerated, and defers palliative ADT with a median 38mo in OMPca |
| Ost, 2014 [133] | 3iii/Diii | R | 450 | Metachronous mets with controlled primary, + underwent MDT for recurrent PCa | RT or LND | About 50% PFS at 1–3 yrs post-MDT | MDT promising approach for OM PCa recurrence but low level of evidence |
Abbreviations: M1 = distant metastases; LT ADT = long-term androgen deprivation therapy; FFS = failure-free survival; OS = overall survival; CR = castrate resistance; met = metastasis; RT = radiation therapy; OM = oligometastasis; LNs = lymph nodes; RP = radical prostatectomy; PCa = prostate cancer; HDRT = high dose radiation therapy; ADT = androgen deprivation therapy; SBRT = stereotactic body radiation therapy; HT = hormone therapy; PFS = progression free survival; LN = lymph node; OM PCa = oligometastatic prostate cancer; PLND = positive lymph node dissection; LC = local control; PSA = prostate specific antigen; PCSS = prostate cancer specific survival; AS = active surveillance; MDT = metastasis directed therapy; DT = doubling time; ADT-FS = androgen deprivation free survival; LND = lymph node dissection; PFS = progression free survival