Oligometastatic cancer is an early type of stage 4 prostate cancer that has spread to other parts of the body, but only to a limited extent – often defined as three to 5 areas outside the prostate gland, mostly On lymph nodes or bones. .
Barely a decade ago it was considered universally fatal, and treatment was limited to systemic hormonal therapy that blocks testosterone, the hormone that causes tumors to grow. But now, exciting advances in the sphere are resulting in recent treatment strategies which are improving patient survival in clinical trials.
This strategy has been enabled by advances in medical imaging, revealing metastatic tumors that were previously too small to see. Doctors can now treat tumors directly with radiation or surgery. It's called metastasis-directed therapy (MDT), and it's allowing some men with oligometastatic prostate cancer to delay or completely avoid hormonal therapy, with its troublesome unwanted side effects.
Now, the outcomes from one Important new study show that helpful responses to MDT are sustained with long-term follow-up.
Researchers' methodology
To generate the outcomes, the researchers combined the outcomes of two previous studies that randomized men to either MDT or statement: one called STOMP and the opposite ORIOLE. The men within the study were treated with a method called stereotactic ablative radiotherapy, which focuses intense beams of radiation on the tumor from multiple directions while sparing healthy tissue. Taken together, the study shows that MDT delays the progression of cancer and the following need for hormonal therapy. After they were published, MDT began to be more widely adopted.
For this recent study, STOMP and ORIOLE subjects were combined into a gaggle of 116 men with a mean follow-up of 52.5 months. The aim of the research was to match the difference in progression-free survival (how long it takes for the cancer to progress) between men treated with MDT and those that weren't treated.
The results showed a transparent profit from radiation: progression-free survival lasted 11.9 months, on average, in men treated with MDT, compared with 5.9 months in untreated controls.
But the researchers also went a step further: They analyzed archived samples of the topics' blood and tumor tissues for cancer-associated mutations in five different genes: ATM, BRCA1, BRCA2, Rb1, and TP53. Again, the information revealed a stark contrast: In men with not less than one mutation, progression-free survival lasted a mean of seven.5 months, compared with a mean of 13.4 months in those with none. was
Notably, progression-free survival continued for 4 years or longer in 20% of men treated with MDT, no matter comorbidity. But generally, men lacking the mutations had the very best response. MDT alone may initially be sufficient for these men, the researchers concluded, while in those with high-risk mutations, MDT could also be more practical if paired with systemic therapy.
An expert's response
Selecting the precise patients for treatment is critical, however the identified variants “may allow us in the future to determine who will benefit most from MDT,” he said. It could also be, Dr. Agdam said, that MDT itself offers a pathway to longer-term, disease-free periods amongst patients treated in given community settings. “Longer studies would be needed to clarify this,” he said, “but the possibility that a good proportion of patients could delay ADT for a longer period of time.”