Treatment of the primary tumor in metastatic prostate cancer
- 278 Downloads
The cornerstone of treatment for metastatic prostate cancer patients has been conventional androgen deprivation therapy, with additional systemic therapy initiated only after castration resistance, and local therapy reserved for palliation. Compelling results from modern trials challenge this paradigm, arguing for initiating escalated hormone therapy and/or chemotherapy during the castration-sensitive disease state for many patients. Furthermore, modern radiotherapy techniques allow for local control of disease with low risk of toxicity. Finally, new PET probes with enhanced sensitivity and accuracy are likely to become a part of routine staging and will lead to an increased incidence of patients with metastatic disease at presentation, with a shift toward identification of patients with limited metastatic disease. As such, the landscape is primed for investigations aimed to explore the role of primary tumor therapy for patients with metastatic prostate cancer. We review the existing data evaluating primary tumor therapy for patients with metastatic prostate cancer and describe ongoing clinical trials testing the hypothesis that primary tumor therapy may benefit patients with metastatic prostate cancer.
KeywordsProstate cancer Oligometastatic Radiotherapy Hormone-sensitive metastatic
YY: data collection, data analysis, manuscript writing. AUK: data collection, data analysis, manuscript writing. NGN: data collection, data analysis, manuscript writing.
Compliance with ethical standards
Conflict of interest
The authors have no potential conflicts of interest to disclose. As this is a review article, there was no research involving human participants or animals, nor informed consent needed.
- 1.Mohler JL, Lee RJ, Antonarakis ES et al (2018) National Comprehensive Cancer Network. Prostate Cancer (Version 4.2018). https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 16 July 2018
- 4.James ND, Spears MR, Clarke NW et al (2015) Survival with newly diagnosed metastatic prostate cancer in the “Docetaxel Era”: data from 917 patients in the control arm of the STAMPEDE trial (MRC PR08, CRUK/06/019). Eur Urol 67:1028–1038. https://doi.org/10.1016/j.eururo.2014.09.032 CrossRefGoogle Scholar
- 20.du Bois A, Reuss A, Pujade-Lauraine E et al (2009) Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 115:1234–1244. https://doi.org/10.1002/cncr.24149 CrossRefPubMedGoogle Scholar
- 22.Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241: 715–722:discussion 722–724Google Scholar
- 24.ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. PubMed NCBI. https://www.ncbi.nlm.nih.gov/pubmed/27380959. Accessed 2 Oct 2018
- 27.DallEra MA, Lo MJ, Chen J et al (2018) Nine-year prostate cancer survival differences between aggressive versus conservative therapy in men with advanced and metastatic prostate cancer: local therapy in advanced prostate cancer. Cancer 124:1921–1928. https://doi.org/10.1002/cncr.31285 CrossRefGoogle Scholar
- 33.James ND, Spears MR, Clarke NW et al (2014) Impact of node status and radiotherapy on failure-free survival in patients with newly-diagnosed non-metastatic prostate cancer: data from > 690 patients in the control arm of the STAMPEDE trial. Int J Radiat Oncol Biol Phys 90:S13. https://doi.org/10.1016/j.ijrobp.2014.05.095 CrossRefGoogle Scholar
- 36.Satkunasivam R, Kim AE, Desai M et al (2015) Radical prostatectomy or external beam radiation therapy vs no local therapy for survival benefit in metastatic prostate cancer: a SEER-medicare analysis. J Urol 194:378–385. https://doi.org/10.1016/j.juro.2015.02.084 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Steuber T, Berg KD, Røder MA et al (2017) Does cytoreductive prostatectomy really have an impact on prognosis in prostate cancer patients with low-volume bone metastasis? Results from a prospective case-control study. Eur Urol Focus 3:646–649. https://doi.org/10.1016/j.euf.2017.06.016 CrossRefPubMedGoogle Scholar
- 44.Boevé LMS, Hulshof MCCM, Vis AN et al (2018) Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol. https://doi.org/10.1016/j.eururo.2018.09.008 CrossRefPubMedGoogle Scholar