OMPC considered to have 3-5 metastatic lesions.
An abscopal effect may be beneficial in patients with metastatic disease, when the primary tumor is treated.
A proposed biological mechanism for improved clinical outcomes with local therapy is the reduction of total tumor burden, where higher tumor burden is associated with greater expression of cancer stem cell markers.
Information is evolving to understand that OMPC may be amenable to local therapy.
Patients with newly diagnosed prostate cancer that have more than seven lesions probably will not benefit from local therapy.
Prospective trials have demonstrated a greatest survival benefit when local therapies combined with systemic therapy than when systemic therapy is given alone.
Randomized controlled studies found that local radiation does not improve overall survival in patients with high volume metastatic prostate cancer but may improve overall survival in patients with low value metastatic prostate cancer.
Episodes of tumor regression in distal sites have been reported in cryoablation and radiation therapy for local disease.
Multi centered randomized trials found that local radiation therapy did not improve overall survival in patients with high volume metastatic prostate cancer but may improve overall survival in patients with low-volume metastatic prostate cancer.
Staging techniques alter the number of large lesions discovered as conventional imaging with CT, MRI or bone scan is less efficient as molecular imaging such as PSMA PET scans.
There are biologic and clinical differences between patients, depending on how oligometastatic disease is detected: in the conventional imaging group there are higher PSA levels at the time of metastasis, with more likelihood to have TP 53 and other adverse mutations in their primary tumor, and had an overall worse survival in comparison with patients whose diagnosis of oligometastasis was based on advanced molecular imaging: this suggests there are probably two different types of biology, even though they both use the same cut off of 3 to 5 metastatic lesions.
Studies are underway to evaluate prostatectomy or radiation to the prostate in the presence of metastatic disease.
The current standard care for patients with synchronous or de novo disease that is low volume is systemic therapy, which consist of hormone therapy with a luteinizing hormone, releasing hormone agonist or antagonist plus an androgen receptor pathway, inhibitor such as enzalutamide, apalutamide or abiratone.