Oligometastatic Prostate Cancer - The Current Role of Prostate Directed Therapy in the Context of Modern Systemic Treatment.

The landscape of oligometastatic prostate cancer is constantly changing due to the development of new imaging techniques and the emergence of new therapies. Androgen deprivation therapy, combined with androgen receptor targeted therapies or with a cytotoxic agent, the main treatment strategy for metastatic prostate cancer for the last 10 years, has not improved significantly the outcomes of patients with limited metastatic burden. Good quality evidence continues to grow and support the usage of local therapies in oligometastatic disease. The strength of the available evidence lies in favor for external beam radiotherapy and several international guidelines recommend nowadays RT as a pivotal strategy in patients with limited metastatic burden. Although data assessing the efficacy of cytoreductive prostatectomy appear promising, the lack of data from prospective randomized trials restricts its usage outside clinical trials. However, cytoreductive prostatectomy or cystoprostatectomy decrease the rates of loco-regional complications, even in castrate resistant state, in patients with symptoms due to bladder or ureteric invasion. In addition, surgery presents the advantage of yielding tissue for molecular analysis, which would allow further understanding of the biology of oligometastatic disease. [ABSTRACT FROM AUTHOR]