Page 9 - Uro_Onco_booklet

Part 5: Management of Men with Oligometastasis

No. Statements
The definition of oligometastasis in prostate cancer
1 remains undetermined but the general principle of ≤ 5
metastases is being accepted.
Oligometastasis can be either synchronous (de
novo with uncontrolled primary prostate tumour) or
2
metachronous (oligo-recurrence with controlled primary
prostate tumour).
The presence of oligometastasis may occur with prior
3 ADT (castration-resistant oligoprogression) or without
prior ADT (castration-naïve oligometastasis).
Metastasis-directed therapy (MDT) provides excellent
local control at the sites of oligometastasis. MDT may
have the potential to spare or to delay the toxicity
4 associated with the use of systemic therapies in
the setting of oligometastasis. Both RT, particularly
stereotactic body RT (SBRT), and surgery have been
investigated for this approach.
At this juncture, the practice of MDT in patients with
5 oligometastasis remains investigational. Optimal patient
selection for MDT remains challenging.
6 Local treatment to the primary prostate tumour in the
presence of oligometastasis remains investigational.
In patients with locally advanced prostate cancer with
limited regional nodal oligometastases, ADT together
7
with surgery or RT, or surgery followed by RT, seems
better in terms of disease control than ADT alone.
A multi-modal approach is needed, with surgery, RT
8 and systemic therapy, alone or in combination, for
the improvement of patient outcomes in patients with
oligometastases.

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