Treatment of primary oligometastatic prostate cancer

Background Multimodal treatment concepts are gaining in importance in the treatment of prostate cancer patients with primary oligometastatic disease. Data from randomized studies show that survival advantages can be achieved in this patient collective by the combination of local and systemic treatment compared to systemic treatment alone. Objective To analyze the available data on therapeutic approaches for oligometastatic prostate cancer. Material and methods Summary and discussion of current studies on systemic and local treatment of de novo oligometastatic prostate cancer. Results Systemic treatment continues to be the standard of care in the oligometastatic stage of prostate cancer. Furthermore, irradiation of the prostate is recommended for patients with a low metastasis burden after this led to an extension of the overall survival in a randomized phase III study. Large case series suggest that radical prostatectomy can also improve oncological endpoints. The results of prospective phase II studies on metachronous metastatic disease provide evidence that local ablative radiotherapy of individual metastases can improve progression-free survival; however, the value of this approach in de novo metastatic disease is just as unclear as that of a triple treatment combination consisting of local and extended systemic treatment. Conclusion In addition to systemic treatment, irradiation of the prostate is a new standard of care for the oligometastatic stage ("low tumour burden").