Local Therapeutics for the Treatment of Oligo Metastatic Prostate Cancer

Oligometastatic prostate cancer (OMPC) presents an opportunity for localized treatments targeting the disease prior to widespread metastasis. Recently, multiple therapies have been proposed for OMPC including cryoablation, radiation therapy, and cytoreductive prostatectomy.

Cryosurgery has been hypothesized that the residual tumor antigens produce an inflammatory microenvironment and induce anti-tumor immune responses, and this may contribute to the survival benefit associated with local treatments for mPCa, Cryoablation is being investigated currently in combination with ADT or chemotherapy. Radiation therapy, especially EBRT has shown promising overall survival benefit in recent trials. Cytoreductive prostatectomy for OPMC is being explored in a number of ongoing clinical trials, with promising preliminary results from the SIMCAP trial. Treatment selection is still controversial, and in most cases, OPMC should be considered experimental. Ultimately there should be comprehensive shared decision making before pursuing these treatments in patients with OPMC until robust randomized comparative clinical trials can be performed.

Written by: Soum Lokeshwar, MD, MBA, Department of Urology, Yale School of Medicine, New Haven, CT

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