New Treatment Approach For Patients With Oligometastatic Prostate Cancer

Advancements in scanning technology have opened up a new treatment option for men with what is described as oligometastatic prostate cancer.

Oligometostatic cancer is defined as follows: patient has had primary treatment for prostate cancer, but a rising PSA which indicates treatment has not cleared the disease. ‘Oligo’ means a small number and oligometostatic refers to patients with three or less sites of metastases.

Defining and identifying oligometastatic prostate cancer

Defining the patients who have oligometostatic prostate cancer has traditionally been challenging, due to limitations in our ability to see very small metastases in standard scans. This means that some patients have a rising PSA after primary treatment and are then given ‘salvage radiotherapy’ to the prostate, on the basis that this is the most likely site of cancer recurrence. But we are treating the cancer ‘blind’ because we are not entirely certain where it is.

Very recent advancements in scanning technology are transforming the management and options for these patients. A number of Birmingham Prostate Clinic patients have travelled to Germany for Gallium-PSMA scans which identify small metastases which would not otherwise be visible in standard scans. In the UK, choline based PET scans are also being used to achieve new levels of accuracy. This means:

• We are better able to accurately define patients with a small number of metastases (oligometastatic prostate cancer)
• We are better able to accurately define patients with a small number of metastases (oligometastatic prostate cancer)

What treatment is offered?

At Birmingham Prostate Clinic we have provided site specific treatment for men with oligometostatic prostate cancer. This is dependent upon the following:

• Clear, accurate information from a PET scan (Gallium-PSMA currently appear to be the most helpful for prostate cancer)
• Three or fewer metastases

For this group of patients we have undertaken two different types of treatments: surgery and Cyberknife radiotherapy. Which option is chosen will depend upon:

• Site of the metastases (may be more suitable for Cyberknife or surgery)
• Patient individual preference
• Multi-disciplinary team case review

For some patients, this active treatment may have a curative intent. For others, it may be an effective alternative to commencing hormone therapy and this may be preferred to the side-effects that can be caused by hormone therapy.

Audit and evaluation

This is a new area – until very recently, patients with rising PSA following primary treatment would either be offered active surveillance if asymptomatic, or would move on to hormone treatment and established approaches for advanced prostate cancer.

The opening of this new treatment approach has arisen from improvements in scanning techniques, but inevitably at this point, there is not a large amount of study evidence for the benefit of this approach compared to the standard pathway.

At BPC, any patient with oligometastatic prostate cancer who has site specific treatment will be reviewed in a prospective audit.