The STOMP Study.

[pjoshea13]

New study below [1].

Should interest those with 'few' mets.

It's a study from Belgium:

"Surveillance or metastasis-directed Therapy for OligoMetastatic Prostate cancer recurrence (STOMP)".

In 2016 when I had a solitary spinal met treated, my radio-oncologist pointed out that there was no proof that survival would be affected.

Back in 2014, the Begian team published the protocol for the study [2]. It's a full text link, so it gives some useful background.

The basic idea was to use treatment or surveillance - no ADT in either arm - & then measure time to ADT initiation.

"the median ADT-free survival was 13 months ... for the surveillance group and 21 months ... for the MDT group"

"MDT" is a new acronym to me: "metastasis-directed therapy". It encompasses surgery & radiation.

What is oligometastatic PCa? In this case it means no more than 3 mets. My guy would not have treated 3 mets. Other definitions go up to 5 mets.

For MDT radiation, the mets should not be in regions that have already received radiation.

The take-home message is that there is value in PCa debulking.

Elsewhere, some have written of oligometastatic cancer treatment as potentially leading to a durable remission. Note that the study design (i.e. no other treatment) was necessary to prove benefit. Actual treatment of oligometastatic PCa could involve various other therapies in addition to MDT.

-Patrick

[1] ascopubs.org/doi/abs/10.120...

[2] ncbi.nlm.nih.gov/pmc/articl...

[BigRich]

I believed in 2002 that there was value in PCa debulking, that is why I had cryrosurgery.

Rich

[snoraste]

The max number of mets is a bit curious. I can imagine that the efficacy of the procedure will go down with higher number of mets (all else equal), but I cannot imagine that somehow going from 5 mets to 6 , the method becomes completely ineffective (clinically speaking). And really, why stop at 6?

I heard there was a clinical trial addressing the efficacy of surgery in advanced PCa, based on some earlier anecdotal evidence.

[pjoshea13 in reply to snoraste]

They could have limited the study to one met, to get proof of concept.

When there is more buy-in, someone will want to know the survival benefit of treating 1, 2, 3, ... n mets. Instinctively, we expect a declining benefit, but who knows.

The experience with other cancers might be instructive. The PCa community has been late to the oligometastatic treatment party.

-Patrick

[snoraste in reply to pjoshea13]

I just put a call thru my MO at MSK about this. It is interesting that their own chief of Urology is heavily in favor:

afr.com/lifestyle/health/me...