New concepts in prostate cancer management: the conundrum of managing oligometastatic disease in prostate cancer-through the looking glass darkly

Abstract

The management of oligometastatic prostate cancer continues to stimulate as well as vex cancer professionals since the concept was raised more than two decades ago. The use of regular prostate-specific antigen (PSA) monitoring together with advances in imaging technology such as combined positron-emission tomography (PET)/computed tomography (CT) has enable earlier identification of potential initial spread of disease and recurrence. Recent systematic reviews and trials have supported the feasible and safe delivery of local ablative therapies for oligometastatic lesions with high local control rates and low morbidity. This is very appealing not only to the clinician but hugely to the patient; however, many questions remain as to whether this patient cohort is prognostically and clinically relevant as well as ultimately if local aggressive therapies can alter the natural history of disease progression and benefit these men. This overview examines the issues for identification, treatment, and management of men with oligometastatic prostate cancer.