Direct effects

Top Line: Does metastasis directed therapy alone delay the need for systemic therapy in patients with oligorecurrent prostate cancer?

The Study: The ORIOLE and STOMP trials evaluated the use of metastasis directed therapy (MDT) alone (no ADT) in patients with oligometastatic prostate cancer. This retrospective study from a Mayo Clinic registry of C-11 choline PET analyzed outcomes for patients oligorecurrent prostate cancer treated with MDT. Included patients had biochemical recurrence after prior radical prostatectomy or primary radiation and a solitary site of metastatic disease that was treated with surgery or SBRT MDT and no ADT. Despite this very narrow inclusion criteria, 124 patients were identified. Just over half (54%) had surgery, and most of those patients (91%) had lymph node disease. Median pre-MDT PSA was 2.2, which declined to 0.15 at 3 months. In contrast, most of the patients treated with SBRT had bone metastasis (94.7%). PSA kinetics are different after radiation, and the median PSA declined from 2.7 pre-MDT to 1.3 at 3 months. Among those who had surgery, median time to biochemical progression was 8.3 months, and the rate of 3-year bPFS was 17.9%. Median time to initiating systemic therapy was 18.5 months. In the SBRT group, median time to biochemical progression was 9.5 months, and the rate of 3-year bPFS was 12.3%. Median time to initiate systemic therapy was 17.8 months.

TBL: In this single center study, surgery was the primary form of MDT for lymph node oligorecurrences while SBRT was used for bone oligorecurrences. Both forms of MDT successfully delayed disease progression and initiation of systemic therapy.