We have detected that you are using an Ad Blocker.
PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.
We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.
The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.
Please provide your AHPRA Number to ensure that you are given the correct level of access to our site.
featured

Expert Opinion / Cases · December 02, 2014

Role for Treatment of the Primary Tumor in Newly Diagnosed Oligometastatic M1b Prostate Cancer?

Written by
Zachary L Smith MD

 

Additional Info

Disclosure statements are available on the authors' profiles:

Discuss This item Follow

No comments yet, be the first to start the discussion!

  • Jacques Planas

    I think it is a strange case, I'm not used to see patients with metastatic disease and such a low PSA level with a Gleason 4+3... I would rather repeat the prostate biospy before taking any decision. Nevertheless I think treatment of the primary tumors in oligometastatic patients may play a favorable role in patient's outcome


  • Norbert Piotrkowicz

    I would offer this patient a passibility of radical treatment with 3 mts. neo-adjuvant MAB + 3x12Gy HDR 3D Real Time Brachytherapy to the prostate + 50Gy/10fr ext. beam to the bone leasion + consecutive MAB for 21 mts. The final decision should of course be made in compliance with patient's expectations.


  • Christopher Eden

    There is a role, as suggested by 2 radiation studies (PRO-7 and SPCG-7) and the recent Eur Urol papers by Culp (2014) and Fossati (2015), all of which demonstrate a survival advantage from treating the primary in oligometastatic prostate cancer. The survival advantage appears to be greater for surgery, probably explicable by the self-seeding hypothesis. However, as Chapain wrote in his editorial in Eur Urol on the subject in 2014, this ought to be done in the context of a trial as it is not mainstream treatment and further knowledge on this subject is needed. According to www.clinicaltrials.gov there are 7 trials on oligometastatic ca prostate ongoing in the US, 6 of which are still recruiting and one of which includes surgery. A multi-centre European study (TRoMbone) addressing this issue is set to start recruiting sometime later this year.


  • juan carlos velez roman

    ADT with analogues LHRH + radioterapy 3D or IMRT a prostate for control de primary Optional Radical Prostatectomy + extendend linphadenectomy and Adt


  • Zachary Smith

    Jacques Planas: Why would you rebiopsy the patient? How would this alter your management? Christopher Eden: I agree with you. We have a limited series of RARP in this setting (unpublished data) over the last few years and the patients have fared well thus far (obviously, limited follow-up). This is an interesting topic and will likely see a growing body of literature and pursuant interest from urologists over the next few years. The clinical trials are good evidence of this.


  • David's Margel

    This is a very unusual case, with early metastatic disease and a very low PSA. On Pathology were there any neuro endocrine features? Did the patient have a family history suggestive of BRCA- in my experience there may be a discrepancy between PSA and cancer among BRCA carriers


  • fabio arena

    Radical prostatectomy and radiotherapy for bone metastasis


  • Zachary Smith

    @David Margel: There were no neuroendocrine features on any of his biopsies. He was not tested for BRCA, however, that is an interesting potential corollary.


  • Andrew See

    I think Robot assisted RP then SRS to bone met, agree 50Gy/10 as per Belgian trial then hold off with ADT for moment and watch PSA, participation in trial given 'unusual' clinical scenario


  • Daniel Freitas

    I agree this is an unusual PSA value for metastatic disease. I could consider templates review by pathologist or even a new rebiopsy targeted to the abnormal area in MRI.


  • Jan 24, 2021

    Pending Moderator approval.
    Delete

Further Reading