Search the Community

The European Society for Medical Oncology (ESMO) has just had its Annual Conference in Copenhagen. Click here and here for 2 reports from Practice Update about some of the things discussed at ESMO 2016 and the implications for patients.

"There are differing schools of thoughts regarding whether oligometastases represent isolated lesions—where targeted therapy may render a patient disease free—or whether they coexist with micrometastases, where targeted therapy in addition to systemic therapy is required for maximal clinical impact. As such, the approach to the patient with oligometastatic prostate cancer requires multidisciplinary consideration, with surgery, radiotherapy, and systemic therapy potentially of benefit either singularly or in combination. Indeed, mounting evidence suggests durable disease-free intervals and, in some cases, possibly cure, may be achieved with such a multimodal strategy. However, selecting patients that may benefit most from treatment of oligometastases is an ongoing challenge. " Click on this link to read a paper on oligometastatic prostate cancer from the 2016 American Society of Clinical Oncology (ASCO) Scientific Meeting.

The Pilot study of Patients with Oligometastases from Prostate cancer treated with STereotactic Ablative body Radiosurgery (POPSTAR) trial is no longer recruiting. I was at Peter Mac for one of my regular follow-up visits (21 months after stereotactic radiation). No results have been published for this study but apparently some trends are developing. Talking to my radiology oncologist I got the impression that, although the stereotactic radiation had successfully sterilised the metastases being treated, many of the patients (including me) had further metastases develop. There were a few patients who had not had any recurrence after their treatment. Were the patients on the study who progressed after stereotactic radiation truly oligometastatic? Or did we already have the further metastases which did not show up on imaging at the time but are being detected now by improved imaging technology? I’ve recently read a study* which said that it is important to define the true oligometastatic stage and suggests that there are differences between polymetastatic, oligometastatic, or oligo-recurrent disease. The study said that a patient who is oligometastatic on diagnosis is not the same as one who is oligometastatic after treatment. Poly = many. Oligo = few. Improvements in imaging (eg Ga68 PET Scans) are going to make easier in the future to define the true oligometastatic stage. In my opinion (I’m not a doctor) there is a benefit in sterilising known metastases with stereotactic radiation even in cases which are not truly oligometastatic. Although not curative, this treatment reduces cancer load in the body, eliminates a potential source of further metastases and hopefully delays progression of the cancer. My radiology oncologist says that he’d like to think this too but at present we don’t have any evidence. * Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options Moreno et al. Radiation Oncology2014,9:258 http://www.ro-ournal.com/content/9/1/258

The Prostate Cancer Foundation of Australia has posted a video on YouTube of the following talk on Radiation Therapy for Prostate Cancer given by radiation oncologist A/Prof Michael Izard at Sydney Adventist Hospital on 22 June 2015 .

An interesting interview with Professor Steven Joniau during the European Urology Association 2015 Annual Conference earlier this year about Oligometastatic Prostate Cancer. What is the definition of Oligo-metastatic Prostate Cancer? What are the new imaging modalities and how are they going to change the landscape? How does this change the landscape? Is it ready for clinical implementation? Closing remarks and take home message Click on this link to view the video.

Dr Eugene Kwon of the Mayo Clinic describes himself as a someone who is "innovative, who pushes the envelope" and who treats "aggressively." Here is a very interesting talk given by him at the 2014 PCRI Conference. Greater emphasis should be placed on identification and treatment of oligo-mets Treatments should focus on potentially curative and not "palliative" outcomes Available agents and technologies should be combined aggressively to evoke better outcomes Must abandon irrational obsession with one-step palliative approaches that have no prospect of cure and only prolong inevitable failure Click this sentence to watch the talk on YouTube.