Oligometastatic Hormone-Sensitive Prostate Cancer. Why Radiotherapy?
Androgen deprivation therapy (ADT) has been considered for years the standard initial treatment for patients with metastatic prostate cancer (mPC). Recently published results support the use of taxanes, second-generation antiandrogens or radiotherapy to the primary tumor as part of the treatment in these patients, considering ADT alone as suboptimal. Metastasis-directed therapy (MDT) is used as part of the treatment for oligometastatic patients in different tumor types. In oligometastatic hormone-sensitive prostate cancer the role of MDT is being studied with promising results. In the present review we assess the available evidence for radiotherapy to the primary tumor in newly diagnosed mPC and for MDT in oligometastatic prostate cancer, as well as future directions in this clinical setting.
The available clinical evidence already warrants the benefit of adding radiotherapy to the primary tumor to standard ADT in patients with synchronous mHSPC and low tumor volume. This option complements the use of second-generation hormonal therapy and ADT, which have demonstrated their efficacy in this subgroup of patients.
In the context of treatment intensification, SBRT in oligometastatic HSPC can be considered an additional treatment choice for selected patients.