According to a study published in The Journal of Urology, metastasis-directed treatment without androgen deprivation therapy has emerged as a potential alternative for men with a solitary oligorecurrent prostate cancer. In the metastasis-directed treatment approach, surgery or stereotactic body radiation therapy (SBRT) is used specifically to target the area of cancer spread.

“Metastasis-directed therapy has been a controversial approach to management of solitary metastatic recurrences of prostate cancer,” said Jack R. Andrews, MD, of Mayo Clinic Arizona, Phoenix, in a press release. “Our study is the first to show benefits of both surgical and radiation therapy metastasis-directed treatment without [androgen-deprivation therapy] in this group of patients, potentially delaying the need for systemic treatment.”

Dr. Andrews and colleagues focused on 124 patients with a solitary metastatic lesion on C-11 choline PET imaging whose primary tumor has already been treated to explore outcomes of metastasis-directed treatment without concomitant androgen-deprivation therapy from 2008 to 2018. Metastasis-directed treatment consisted of either SBRT or surgical excision.

Results showed that both types of focused treatment were effective in terms of biochemical recurrence. This was reflected by reduction in prostate-specific antigen (PSA) levels. After surgery, PSA levels decreased by about half in 80.5% of patients after metastasis-directed treatment. Most patients eventually needed androgen-deprivation therapy or other systemic therapy for progressive cancer. However, at 3-year follow-up, 29% of patients were alive and free from cancer progression. In the radiation therapy group, 40.3% of patients had a reduction in PSA levels by half.

Therefore, these results suggest that metastasis-directed treatment without androgen-deprivation therapy may delay initiation of systemic therapy. It also highlights the need for further prospective studies of select patients with solitary metastatic recurrences of prostate cancer.

Source: JNCCN