14 Primary hormone sensitive oligometastatic PCa

Question 1

Prognostic factors in metastatic prostate cancer

Answer 1

Median survival of pts with newly diagnosed metastases synchronous mHSPC) is approximately 42 months with ADT alone, however, it is highly variable since the M1 population is heterogeneous. Several prognostic factors for survival have been suggested including the number and location of bone metastases, presence of visceral metastases, ISUP grade, PS status and initial PSA and alkaline phosphatase level, but only few have been validated.

Question 2

High Volume PCa

Answer 2

Visceral Mets AND/OR
> 4 Bone metastasis
> 1 outside vertebral column

Question 3

High Risk Disease PCa

Answer 3

at least 2 high features
> Gleason 8
Visceral Mets
> 3 Bone Metastasis

Question 4

Volume of disease per CHAARTED

Answer 4

‘Volume‘ of disease as a potential predictor was introduced by CHAARTED (Chemo-hormonal Therapy versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer)

Question 5

High Volume and High Risk Disease in PCa

Answer 5

Question 6

Metastatic prostate cancer : Treatment

Answer 6

ADT has been the SOC for over 50 years
No high-level evidence in favour of a specific type of ADT for oncological outcomes, neither for orchiectomy nor for a LHRH agonist or antagonist.

Question 7

Metastatic prostate cancer : Treatment - LHRH agonist or antagonist?

Answer 7

The level of testosterone is reduced much faster with orchiectomy and LHRH antagonist, therefore patients with impending spinal cord compression or other potential impending complications from the cancer should be treated with either a bilateral orchidectomy or LHRH antagonists as the preferred options.

Question 8

Radiotherapy to the primary tumour for newly diagnosed, metastatic PCa (STAMPEDE)

Answer 8