Dr. Einstein on Treatment Approaches in Early Oligometastatic Prostate Cancer

David J. Einstein, MD, instructor of medicine, Harvard Medical School, attending physician, Beth Israel Deaconess Medical Center, discusses treatment approaches for patients with early evidence of oligometastatic prostate cancer.

There’s a question of whether oligometastatic recurrences can be detected early and treated with metastasis-directed therapy with radiation or surgery, says Einstein. That approach was tested in the phase II STOMP trial and showed that metastasis-directed therapy could delay the need for systemic androgen deprivation therapy, an approach that is associated with many toxicities and is not curative. However, further validation is required, adds Einstein.

Another related strategy is to use metastasis-directed therapy plus intensified systemic therapy to eradicate the disease at first recurrence. Only time will tell which approach is superior. In the meantime, there are 2 other trials being conducted in this area—the phase II ORIOLE trial and the phase II METACURE trial—which are testing different methods in the early oligometastatic recurrent setting.