[Metachronous oligometastatic prostate cancer-the more the better or only local treatment?]

Background: Prostate cancer metastases may occur at diagnosis (de novo) or metachronous after treatment for localized disease.

Objective: To describe location, prognosis, and individual treatment concepts for metachronous oligometastatic prostate cancer.

Materials and methods: Analysis of current treatment guidelines and literature for hormone sensitive, metachronous metastatic prostate cancer.

Results: Modern imaging modalities lead to earlier diagnosis of metachronous oligometastatic prostate cancer, which offers the opportunity to develop metastasis-directed treatment concepts. Oligometastatic recurrence may occur in locoregional lymph nodes (N1) or as distant disease (M1). N1 disease is predominantly treated by salvage lymph node dissection or radiation. Distant metastasis may be radiated in order to delay systemic treatment. The combination of androgen deprivation and novel androgen receptor-targeted drugs such as apalutamide or enzalutamide are associated with a significant survival benefit compared to castration alone in bone or visceral oligometastatic metachronous disease.

Conclusion: Metachronous oligometastatic prostate cancer is heterogeneous with slow progression compared to men with high volume metastasis. Individual treatment concepts may decrease risk of progression and, thus, delay time to medical treatment. Multimodal approaches are currently being evaluated in clinical trials.