A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills?

  • Amine SlaouiEmail author
  • S. Albisinni
  • F. Aoun
  • G. Assenmacher
  • W. Al Hajj Obeid
  • R. Diamand
  • S. Regragui
  • A. Touzani
  • A. Bakar
  • A. Mesfioui
  • T. Karmouni
  • A. Ameur
  • K. Elkhader
  • A. Koutani
  • A. Ibnattya
  • T. Roumeguere
  • A. Peltier
Original Article



Amongst the unanswered questions regarding prostate cancer (PCa), the optimal management of oligometastatic disease remains one of the major concerns of the scientific community. The very existence of this category is still subject to controversy. Aim of this systematic review is to summarize current available data on the most appropriate management of oligometastatic PCa.

Evidence acquisition

All relevant studies published in English up to November the 1st were identified through systematic searches in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database. A search was performed including the combination of following words: (prostate cancer) and (metastatic) and [(oligo) or (PSMA) or (cytoreductive) or (stereotaxic radiotherapy) or (prostatectomy)]. 3335 articles were reviewed. After title screening and abstract reading, 118 papers were considered for full reading, leaving a total of 36 articles for the systematic review.

Evidence synthesis

There is still no consensus on the definition of oligometastatic disease, nor on the imaging modalities used for its detection. While retrospective studies suggest an added benefit with the treatment the primitive tumor by cytoreductive prostatectomy (55% survival rate vs 21%, p < 0.001), prospective studies do not validate the same outcome. Nonetheless, most studies have reported a reduction in local complications after cytoreductive prostatectomy (< 10%) compared to the best systemic treatment (25–30%). Concerning radiotherapy, an overall survival benefit for patients with a low metastatic burden was found in STAMPEDE (HR 0.68, 95% CI 0.52–0.90; p = 0.007) and suggested in subgroup analysis of the HORRAD trial. Regarding the impact of metastases-directed therapy (MDT), the STOMP and ORIOLE trials suggested that metastatic disease control might improve androgen deprivation therapy-free survival (in STOMP: 21 vs 13 months for MDT vs standard of care). Nonetheless, the impact of MDT on long-term oncologic results remains unclear. Finally, oligometastatic disease appears to be a biologically different entity compared to high-burden metastatic disease. New findings on exosomes appear to make them intriguing biomarkers in the early phases of oligometastatic PCa.


Oligometastatic PCa is today a poorly understood disease. The implementation of new imaging techniques as whole-body MRI and PSMA PET/CT has increased exponentially the number of oligometastatic patients detected. Data of available trials suggest a benefit from cytoreductive prostatectomy to reduce local complication, though its impact on survival remains unknown. Radiotherapy may be beneficial for patients with low-burden metastatic PCa, while MDT may delay the need for androgen deprivation therapy. Results from ongoing trials data are eagerly awaited to draw reliable recommendations.


Prostate Cancer Oligometastatic Cytoreductive surgery Radiotherapy Metastasis-directed therapies 



Androgen deprivation therapy


Computed tomography


External beam radiation therapy


Hazard ratio


Intermediate clinical criteria in prostate cancer


Metastasis-directed therapy


Magnetic resonance imaging




Prostate cancer


Population, intervention, comparator, outcome and study design


Preferred reporting items for systematic reviews and meta analyses


Radical prostatectomy


Stereotactic body radiotherapy


99mTechnetium-methylene diphosphonate


Author contributions

AS: project development, data collection, data analysis, manuscript writing. SA: project development, data collection, data analysis, manuscript writing. FA: project development, data analysis, manuscript writing. GA: project development, data analysis. WAHO: data collection. RD: data analysis, manuscript writing. SR: data collection. AT: data collection. AB: data collection. AM: project development. TK: project development, data analysis, manuscript writing. AA: project development, data analysis, manuscript writing. KE: project development, data analysis, manuscript writing. AK: project development, data analysis, manuscript writing. AI: project development, data analysis, manuscript writing. TR: project development, data analysis, manuscript writing. AP: project development, data analysis, manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Amine Slaoui
    • 1
    • 2
    • 3
    Email author
  • S. Albisinni
    • 4
  • F. Aoun
    • 2
    • 5
  • G. Assenmacher
    • 2
  • W. Al Hajj Obeid
    • 4
  • R. Diamand
    • 4
  • S. Regragui
    • 1
  • A. Touzani
    • 1
  • A. Bakar
    • 4
  • A. Mesfioui
    • 3
  • T. Karmouni
    • 1
  • A. Ameur
    • 6
  • K. Elkhader
    • 1
  • A. Koutani
    • 1
  • A. Ibnattya
    • 1
  • T. Roumeguere
    • 4
  • A. Peltier
    • 2
  1. 1.Urology B DepartmentIbn Sina Hospital, Mohammed V UniversityRabatMorocco
  2. 2.Urology DepartmentJules Bordet Institute, ULBBrusselsBelgium
  3. 3.Laboratory of Genetics, NeuroEndocrinology and Biotechnology, Faculty of SciencesUniversity Ibn TofailKenitraMorocco
  4. 4.Urology Department, University Clinics of BrusselsErasme Hospital, ULBBrusselsBelgium
  5. 5.Urology DepartmentHôtel Dieu-de-France, Saint-Joseph UniversityBeyrouthLebanon
  6. 6.Urology DepartmentMohammed V Military Hospital, Mohammed V UniversityRabatMorocco

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