Real-world treatment of oligometastatic hormone-sensitive prostate cancer: impact of androgen receptor pathway inhibitors, metastasis-directed therapy and primary tumor radiotherapy on survival.

Actas urologicas espanolas Pub Date : 2026-08-03 DOI:10.1016/j.acuroe.2026.502033

P M Samper Ots, D González Santos, E González Del Portillo, A Valcárcel Díaz, O Engel, E Amaya Escobar, M Sánchez Encinas, H Gimbernat Diaz, C Blázquez Vallejo, A Husillos Alonso, D Ramírez Martín, E Useros Rodríguez

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Abstract

Introduction: The management of oligometastatic hormone-sensitive prostate cancer (omHSPC) has evolved with the introduction of androgen receptor pathway inhibitors (ARPi) and the increasing use of local therapies. However, evidence on the combined impact of systemic intensification and local treatment strategies in real-world settings remains limited.

Methods: We conducted a retrospective cohort study including patients with histologically confirmed omHSPC (≤5 metastatic lesions) treated between 2014 and 2023. Treatments included androgen deprivation therapy (ADT) alone or combined with ARPi, prostate radiotherapy (RTp) in de novo metastatic disease, and metastasis-directed therapy (MDT) using stereotactic body radiotherapy. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier methods.

Results: Eighty-three patients were included; 28.9% presented with synchronous and 71.1% with metachronous disease. Treatment with ADT plus ARPi was associated with significantly longer PFS and OS compared with ADT alone. These differences persisted after excluding patients with pelvic nodal oligorecurrence. MDT alone was not associated with improved survival outcomes; however, the combination of MDT and ARPi was associated with longer PFS and OS compared with MDT without ARPi. In patients with de novo disease, RTp did not independently improve survival but was associated with longer OS when combined with ARPi. Treatment-related toxicity was low, with no unexpected adverse events.

Conclusions: In this real-world series of omHSPC, systemic intensification with ARPi was associated with improved clinical outcomes. The combination of ARPi with local therapies such as RTp or MDT may provide additional benefit; however, these findings should be interpreted with caution and warrant prospective validation.

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少转移性激素敏感前列腺癌的现实治疗：雄激素受体途径抑制剂、转移导向治疗和原发肿瘤放疗对生存的影响

随着雄激素受体途径抑制剂（ARPi）的引入和局部治疗的增加，寡转移性激素敏感前列腺癌（omHSPC）的治疗已经发生了变化。然而，在现实环境中，关于系统强化和局部治疗策略的综合影响的证据仍然有限。方法：我们进行了一项回顾性队列研究，包括2014年至2023年间接受组织学证实的omHSPC（≤5个转移灶）治疗的患者。治疗包括雄激素剥夺治疗（ADT）单独或联合ARPi，前列腺放疗（RTp）治疗新转移性疾病，以及使用立体定向体放疗的转移性治疗（MDT）。采用Kaplan-Meier方法分析无进展生存期（PFS）和总生存期（OS）。结果：纳入83例患者；同期病变28.9%，异时病变71.1%。与单独使用ADT相比，ADT加ARPi治疗的PFS和OS明显延长。在排除盆腔淋巴结少发患者后，这些差异仍然存在。单独MDT与改善生存结果无关；然而，与没有ARPi的MDT相比，MDT和ARPi联合治疗的PFS和OS更长。在新发疾病患者中，RTp不能单独改善生存，但与ARPi联合使用时，与更长的生存期相关。治疗相关毒性较低，无意外不良事件发生。结论：在这个现实世界的omHSPC系列中，ARPi的全身强化与改善的临床结果相关。ARPi与局部治疗（如RTp或MDT）联合可能提供额外的益处；然而，这些发现应该谨慎解释，并保证前瞻性验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Actas urologicas espanolas

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