A guide to diagnosis and treatment options
When prostate cancer spreads beyond the prostate to distant organs or the bone, it’s called metastatic prostate cancer. But not all metastatic disease is the same. Some men with prostate cancer develop only a small number of metastatic spots, which is increasingly recognized as a clinical sub-category of metastatic disease, called oligometastatic prostate cancer. Treatment options and goals for those with oligometastatic prostate cancer may be different from those used in widespread metastatic disease.
What does “oligometastatic” mean?
“Oligo” means few. Oligometastatic prostate cancer generally refers to prostate cancer that has spread to a limited number of sites—typically under 3-5 lesions.These metastases are commonly found in bone, lymph nodes, or (occasionally) other organs.
Why do doctors treat oligometastatic differently?
Research suggests oligometastatic disease may represent an “intermediate” stage. This means the cancer is not fully localized but it’s not widespread either. Some patients may benefit from treatments aimed at controlling or even eliminating visible metastases.
How will you know if your prostate cancer is oligometastatic?
Doctors typically use advanced imaging tools to detect small metastases, including PSMA PET scans, a whole-body MRI, CT scans, and bone scans. These advanced imaging technologies allow clinicians to identify smaller metastatic deposits than older methods could detect.
What are the types of oligometastatic prostate cancer?
Clinicians often classify oligometastatic disease into several categories:
- De novo oligometastatic: present at initial diagnosis
- Oligorecurrent: appears after prior prostate cancer treatment
- Oligoprogressive: a few sites grow despite ongoing therapy
Your specific category of oligometastatic disease can influence your personalized treatment decisions. For example, goals for treating oligometastatic prostate cancer typically include:
- Slowing disease progression
- Delaying long-term hormone therapy
- Improving quality of life
- In some cases, achieving long periods with no evidence of disease
What are your treatment options for oligometastatic prostate cancer?
Hormone therapy (Androgen Deprivation Therapy, or ADT)
ADT reduces testosterone levels, which prostate cancer cells need to grow. ADT was the standard first-line treatment for metastatic disease, historically, and is often combined with other therapies today. It can be effective at controlling cancer growth and shrinking tumors. Patients report side effects including fatigue and hot flashes; ADT can also cause bone thinning and metabolic changes.
Metastasis-directed therapy (MDT)
MDT aims to treat individual metastatic spots directly, often using stereotactic body radiation therapy (SBRT). The recent WOLVERINE meta-analysis of seven global studies found that MDT “significantly improved progression-free survival and later endpoints.” Experts believe that MDT has the ability to potentially benefit patients in several ways, such as delayed time to progression and avoidance of therapies that might have a negative influence on quality of life.
Combining SBRT with hormone therapy
Some studies suggest that combination therapy may improve outcomes. The RADIOSA randomized trial found improved progression-free survival when short-course ADT was added to SBRT.
Treating the primary tumor
In men with low-volume metastatic disease, treating the prostate itself (e.g. with radiation or surgical intervention) may improve survival when combined with systemic therapy.
What should I ask my doctor to understand if I have oligometastatic prostate cancer?
Doctors might treat this type of prostate cancer with curative intent, so it’s important to understand if you qualify for relevant treatments. Ask your oncologist:
- How many metastatic spots do I have?
- Am I a candidate for metastasis-directed therapy?
- Should I start hormone therapy now or later?
- Would a clinical trial be appropriate for me?
- What are the potential side effects of each option?
Connect with other patients who have navigated prostate cancer by joining the Outcomes4Me peer Community.
