Oligometastatic prostate cancer: Metastases-directed therapy?

[pjoshea13]

New paper below.

As someone who received treatment for a single spiny met at L5 last year, I am naturally interested in the subject.

"Reports on surgical and radiation treatment for low-volume metastatic recurrence have shown promising results, with definitive cure in few but a relevant delay of androgen-deprivation therapy with both treatment methods."

It's a Belgian paper, which might explain the curious phrasing in the Abstract.

First time I have seen a paper from the "Arab Journal of Urology". I doubt that any of our doctors will read it.

-Patrick

ncbi.nlm.nih.gov/pubmed/275...

Arab J Urol. 2016 Jul 20;14(3):179-82. doi: 10.1016/j.aju.2016.06.004. eCollection 2016.

Oligometastatic prostate cancer: Metastases-directed therapy?

Van Poppel H1, De Meerleer G1, Joniau S1.

Author information

1Department of Urology and Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.

Abstract

Since the introduction of anatomical and functional imaging with multiparametric magnetic resonance imaging and choline or prostate-specific membrane antigen positron emission tomography-computed tomography, we are able to diagnose a previously unknown disease, the oligometastatic prostate cancer after local therapy. Reports on surgical and radiation treatment for low-volume metastatic recurrence have shown promising results, with definitive cure in few but a relevant delay of androgen-deprivation therapy with both treatment methods. Obviously, these results need to be validated with prospective randomised data.

KEYWORDS:

(SB)RT, (stereotactic body) radiotherapy; ADT, androgen-deprivation therapy; BRFS, biochemical recurrence-free survival; CPFS, clinical progression-free survival; CSS, cancer-specific survival; LND, lymph node dissection; Lymph node dissection; Oligometastatic prostate cancer; PET, positron emission tomography; Stereotactic body radiotherapy

PMID: 27547457 DOI: 10.1016/j.aju.2016.06.004

[PubMed]

[Hidden]

Patrick, have you seen this video from Dr Kwon? I don't know if I came across this on this, or another prostate cancer board.

youtube.com/watch?v=Nkqizmv...(Not working as expected?)

[pjoshea13 in reply to Hidden]

It's great to hear success stories. Perhaps the cancers will return at other spots, but for PSA to be 'zero' for several years, & the men not to have to suffer the morbidity of standard treatment during that time, is a really big deal.

[Hidden in reply to Hidden]

very very sensible talk. I should listen to this every day.

[Roy1954]

Hi

I have undergone this treatment in the UK and was the first at my hospital to have the treatment to the bone (SABR). I had 3 treatments consisting of 10gy so 30gy in total to 2 mets in the pelvis which was successful but another met has appeared in one of my ribs which I am having a planning session for tomorrow and treatment shortly after.

[Hidden in reply to Roy1954]

London?

[BrentW]

Writing as an academic, this looks like a lightweight paper that found a home in a lightweight journal. All part of the pressure to publish.

[Hidden in reply to BrentW]

Does your evaluation of the article carry over to a negative opinion of the field of stereotactic body radiation treatment? Do you feel that radiation to a small diameter bone met is unproductive?

[JoelT]

I don't like to put any credence into individual's stories, but I do have to acknowledge that I am very aware of a number of men who did go after the few locally distant mets that had been identified post primary treatment. Most of these men (not all) have been doing very well, often with PSAs that have become and are still undetectable. This isn't to say that their situation will not change, but clearly they have been doing well.

The increase in scanning sensitivity can better identify these mets (we still need more improvement in this area) should make the treatment of oligometastatic disease even more effective.

We also know that debulking the primary tumor can have a positive effect on cancer survival, so at the worse case this can be simply considered a debulking process that might benefit men who have other, unidentified distant mets.

Joel

[Hidden in reply to JoelT]

I like your comment about attacking the primary tumor in the prostate. One urologist told me that if metastases were found in the scans then ADT would be recommended but no surgery to remove the prostate and no radiation treatment of the prostate. That made no sense to me. If the prostate is shedding cancerous cells why wouldn't you attack it at the source even if it has spread?

[Hidden in reply to Hidden]

I think the thinking is that established bone mets are a more severe danger. But I also agree that any shot at long term remission seems to require addressing the gland itself. I am confident that it has been pointed out that in lung cancer and in ovarian cancer, having mets does not preclude treatment to the lung or the ovaries.

I wonder if it could be possible to re-encapsulate the prostate, if nothing else, using some injectible like SPACE-Oar.

[JoelT]

The concept of debulking is not universally accepted, but I see an increasing trend towards acknowledging that it can slow down cancer progression (A retrospective study by Culp and associates in European Urology addressed this question. They used the Surveillance, Epidemiology, and End Results (SEER) database to study almost 8000 men who either received no local therapy or received local therapy with a radical prostatectomy or brachytherapy, despite having a diagnosis of metastatic disease. The analysis revealed a statistically significantly improved overall survival and cancer-specific survival for the groups of men who received local treatment, whether it was surgery or brachytherapy, with surgery being associated with the best overall results, also Heidenreich et al., ncbi.nlm.nih.gov/pubmed/252... as well as others.)

Joel

[Hidden in reply to JoelT]

clinicaltrials.gov/ct2/show...

Trial is recruiting. Multi site

Cytoreductive Prostatectomy in Treating Patients With Newly Diagnosed, Metastatic Prostate Cancer

[Hidden]

"oligometastatic remains a hypothesis"

[Hidden in reply to Hidden]

Go to YouTube and search on Dr Kwon or oligometastatic.

[Hidden in reply to Hidden]

I have seen him. He is a wonderful person. Makes you think that the world could be a wonderful place, and maybe is. And a link to him speaking is higher up this comment chain.