The current role of precision surgery in oligometastatic prostate cancer

TY - JOUR

T1 - The current role of precision surgery in oligometastatic prostate cancer

AU - von Deimling, Markus

AU - Rajwa, Pawel

AU - Tilki, Derya

AU - Heidenreich, Axel

AU - Pallauf, Maximilian

AU - Bianchi, Alberto

AU - Yanagisawa, Takafumi

AU - Kawada, Tatsushi

AU - Karakiewicz, Pierre I

AU - Gontero, Paolo

AU - Pradere, Benjamin

AU - Ploussard, Guillaume

AU - Rink, Michael

AU - Shariat, Shahrokh F

N1 - Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

PY - 2022/12

Y1 - 2022/12

N2 - Oligometastatic prostate cancer (omPCa) is a novel intermediate disease state characterized by a limited volume of metastatic cells and specific locations. Accurate staging is paramount to unmask oligometastatic disease, as provided by prostate-specific membrane antigen-positron emission tomography. Driven by the results of prospective trials employing conventional and/or modern staging modalities, the treatment landscape of omPCa has rapidly evolved over the last years. Several treatment-related questions comprising the concept of precision strikes are under development. For example, beyond systemic therapy, cohort studies have found that cytoreductive radical prostatectomy (CRP) can confer a survival benefit in select patients with omPCa. More importantly, CRP has been consistently shown to improve long-term local symptoms when the tumor progresses across disease states due to resistance to systemic therapies. Metastasis-directed treatments have also emerged as a promising treatment option due to the visibility of oligometastatic disease and new technologies as well as treatment strategies to target the novel PCa colonies. Whether metastases are present at primary cancer diagnosis or detected upon biochemical recurrence after treatment with curative intent, targeted yet decisive elimination of disseminated tumor cell hotspots is thought to improve survival outcomes. One such strategy is salvage lymph node dissection in oligorecurrent PCa which can alter the natural history of progressive PCa. In this review, we will highlight how refinements in modern staging modalities change the classification and treatment of (oligo-)metastatic PCa. Further, we will also discuss the current role and future directions of precision surgery in omPCa.

AB - Oligometastatic prostate cancer (omPCa) is a novel intermediate disease state characterized by a limited volume of metastatic cells and specific locations. Accurate staging is paramount to unmask oligometastatic disease, as provided by prostate-specific membrane antigen-positron emission tomography. Driven by the results of prospective trials employing conventional and/or modern staging modalities, the treatment landscape of omPCa has rapidly evolved over the last years. Several treatment-related questions comprising the concept of precision strikes are under development. For example, beyond systemic therapy, cohort studies have found that cytoreductive radical prostatectomy (CRP) can confer a survival benefit in select patients with omPCa. More importantly, CRP has been consistently shown to improve long-term local symptoms when the tumor progresses across disease states due to resistance to systemic therapies. Metastasis-directed treatments have also emerged as a promising treatment option due to the visibility of oligometastatic disease and new technologies as well as treatment strategies to target the novel PCa colonies. Whether metastases are present at primary cancer diagnosis or detected upon biochemical recurrence after treatment with curative intent, targeted yet decisive elimination of disseminated tumor cell hotspots is thought to improve survival outcomes. One such strategy is salvage lymph node dissection in oligorecurrent PCa which can alter the natural history of progressive PCa. In this review, we will highlight how refinements in modern staging modalities change the classification and treatment of (oligo-)metastatic PCa. Further, we will also discuss the current role and future directions of precision surgery in omPCa.

KW - Male

KW - Humans

KW - Prospective Studies

KW - Prostatic Neoplasms/surgery

KW - Prostate

KW - Prostatectomy

KW - Positron Emission Tomography Computed Tomography/methods

U2 - 10.1016/j.esmoop.2022.100597

DO - 10.1016/j.esmoop.2022.100597

M3 - SCORING: Review article

C2 - 36208497

VL - 7

SP - 100597

JO - ESMO OPEN

JF - ESMO OPEN

SN - 2059-7029

IS - 6

M1 - 100597

ER -