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Focal therapy for primary tumor and metastases in de novo or recurrent oligometastatic prostate cancer: current standing and future perspectives

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Abstract

Purpose

Focal therapy (FT) is gaining increasing acceptance in the management of localized prostate cancer particularly due to its favorable safety. Preliminary evidence suggests advantageous utilization of local treatment in the field of oligometastatic prostate cancer (OMPC). Since data on the utilization of FT in OMPC are scarce, we sought to summarize available evidence.

Methods

For this narrative comprehensive review, we employed PubMed®, Web of Science™, Embase®, Scopus®, and clinicaltrial.gov databases and Google web search engine to seek peer-reviewed articles, published abstracts from international congresses, and ongoing trials in the English language using the terms “prostate cancer”, “oligometastatic”, “hormone-sensitive”, “focal therapy”, “focal treatment”, “cryotherapy”, “ablation”, “cancer” as well as “metastasis-directed therapy. We focused on relevant publications on FT utilized in OMPC targeting the primary or metastatic sites as well as completed and ongoing clinical trials.

Results

Growing evidence points to distinct differences in the biologic behavior and molecular signaling processes of OMPC as compared to polymetastatic disease (PMPC). No established biomarkers are available to accurately identify OMPC yet, while several candidates are currently under investigation. The evolution of molecular imaging is set to aid in selecting patients benefitting most from local management. Differences between OMPC and PMPC should be considered when designing the optimal therapeutic strategy. While efficacy data for FT in comparison to standard care in OMPC are scarce, longer progression-free survival and time to castration resistance have been demonstrated for bone metastatic prostate cancer with the primary tumor treated by cryosurgery followed by androgen deprivation therapy (ADT) compared to ADT alone.

Conclusion

Ongoing research efforts are eagerly awaited to better characterize OMPC and establish customized strategies for patients with this condition.

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Acknowledgements

The following authors are part of EAU YAU Prostate cancer Working Party: Igor Tsaur, Roman A. Blaheta, Maximilian Brandt, Robert Dotzauer, Jonathan Olivier, Giorgio Gandaglia and Christian Surcel.

Author information

Author notes

  1. Igor Tsaur, Roman A. Blaheta and Robert Dotzauer contributed as first authors.

  2. Cristian Mirvald, Jonathan Olivier and Cristian Surcel contributed as senior authors.

Authors and Affiliations

  1. Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany

    Igor Tsaur, Roman A. Blaheta, Robert Dotzauer & Maximilian P. Brandt

  2. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Giorgio Gandaglia

  3. Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, 00238, Bucharest, Romania

    Ioanel Sinescu, Cristian Mirvald & Cristian Surcel

  4. University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

    Ioanel Sinescu, Cristian Mirvald & Cristian Surcel

  5. Department of Urology, Hospital Claude Huriez, CHU Lille, Lille, France

    Jonathan Olivier

  6. Université de Lille Faculté de Médecine Henri Warembourg, Lille, France

    Jonathan Olivier

  7. CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Univ. Lille, 59000, Lille, France

    Jonathan Olivier

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  1. Igor Tsaur
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Consortia

the EAU-YAU Prostate Cancer Working Party

  • Igor Tsaur
  • , Roman A. Blaheta
  • , Maximilian Brandt
  • , Robert Dotzauer
  • , Jonathan Olivier
  • , Giorgio Gandaglia
  •  & Christian Surcel

Contributions

IT: project development, data collection and management, data analysis, manuscript writing, manuscript editing. RAB: project development, data collection and management, data analysis, manuscript writing, manuscript editing. RD: project development, data collection and management, data analysis, manuscript writing, manuscript editing. MPB: manuscript writing, manuscript editing. GG: manuscript writing, manuscript editing. IS: manuscript writing, manuscript editing. CM: project development, data collection and management, data analysis, manuscript writing, manuscript editing. JO: project development, data collection and management, data analysis, manuscript writing, manuscript editing. CS: project development, data collection and management, data analysis, manuscript writing, manuscript editing.

Corresponding author

Correspondence to Cristian Surcel.

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The authors declare that there are no conflicts of interest.

Research involving human participants and/or animals

None.

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Tsaur, I., Blaheta, R.A., Dotzauer, R. et al. Focal therapy for primary tumor and metastases in de novo or recurrent oligometastatic prostate cancer: current standing and future perspectives. World J Urol 41, 2077–2090 (2023). https://doi.org/10.1007/s00345-022-04162-5

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