Real-world treatment of oligometastatic hormone-sensitive prostate cancer: impact of androgen receptor pathway inhibitors, metastasis-directed therapy and primary tumor radiotherapy on survival.

Abstract

IntroductionThe management of oligometastatic hormone-sensitive prostate cancer (omHSPC) has evolved with the introduction of androgen receptor pathway inhibitors (ARPi) and the increasing use of local therapies. However, evidence on the combined impact of systemic intensification and local treatment strategies in real-world settings remains limited.MethodsWe conducted a retrospective cohort study including patients with histologically confirmed omHSPC (≤5 metastatic lesions) treated between 2014 and 2023. Treatments included androgen deprivation therapy (ADT) alone or combined with ARPi, prostate radiotherapy (RTp) in de novo metastatic disease, and metastasis-directed therapy (MDT) using stereotactic body radiotherapy. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier methods.ResultsEighty-three patients were included; 28.9% presented with synchronous and 71.1% with metachronous disease. Treatment with ADT plus ARPi was associated with significantly longer PFS and OS compared with ADT alone. These differences persisted after excluding patients with pelvic nodal oligorecurrence. MDT alone was not associated with improved survival outcomes; however, the combination of MDT and ARPi was associated with longer PFS and OS compared with MDT without ARPi. In patients with de novo disease, RTp did not independently improve survival but was associated with longer OS when combined with ARPi. Treatment-related toxicity was low, with no unexpected adverse events.ConclusionsIn this real-world series of omHSPC, systemic intensification with ARPi was associated with improved clinical outcomes. The combination of ARPi with local therapies such as RTp or MDT may provide additional benefit; however, these findings should be interpreted with caution and warrant prospective validation.