Direct Treatment of All Visible Tumour in Synchronous Oligometastatic Prostate Cancer: Total Eradication of Tumour or the Full Monty Treatment.

Abstract

Recent advances in the management of synchronous oligometastatic prostate cancer (PC) highlight the potential of combining local and systemic therapies. However, there is growing interest in metastasis-directed therapy (MDT) in this setting. When all modalities are combined, this is referred as "total eradication of tumour" (TET) or "full monty treatment" (FMT). Retrospective studies have revealed promising outcomes with approaches such as cytoreductive radical prostatectomy or radiotherapy alongside MDT and combination systemic therapy. Multiple studies have demonstrated a significant proportion of cases with undetectable prostate-specific antigen and noncastrate testosterone, while one comparative trial (± MDT) revealed some evidence of an overall survival benefit. Results from the prospective trials indicate the feasibility and effectiveness of this intensive treatment strategy, with biochemical remission and disease-free states achieved in a significant proportion of cases. Overall, limitations persist, including a reliance on conventional imaging in all studies and the absence of long-term prospective data. Ongoing trials will provide definitive insights into the treatment efficacy and safety of TET/FMT. PATIENT SUMMARY: For patients with a new diagnosis of prostate cancer with only few metastases, cancer control results after treatment with local therapy, hormonal agents, and treatment targeted to all metastatic sites are promising. Further clinical trials of this approach with the inclusion of new scan techniques are eagerly awaited.