Many people know of only two states of cancer: local (in one part of the body) or metastatic (when the cancer has spread to other parts of the body).
However, there is another state of disease that is somewhere in the middle, a state that is featured in this issue of CURE®.
Most types of cancers, including prostate cancer, are managed based on their stage, which is a way to quantitatively describe in what locations of the body cancer has been found. This is usually the first step after an initial diagnosis from a biopsy.
Imaging scans and other tests might reveal early-stage cancer, which is typically localized to the organ of origin and surrounding tissues or lymph nodes. Or it could be termed advanced or metastatic cancer.
In the case of prostate cancer, this would be exemplified by its spreading to bone. The most important distinction between early-stage and advanced-stage cancers is long-term curability.
The term “oligometastatic,” which is the state somewhere in the middle, was first proposed for prostate cancer in 1995. It encompasses a few isolated metastases.
The intriguing aspect of this designation is discovering whether long-term cures can be accomplished. In the past few decades, there have been significant improvements in medical therapies as well as focused radiation and other local therapies that might help reach that goal.
Additionally, more precise imaging such as prostate-specific membrane antigen (PSMA) PET imaging has helped doctors diagnose metastases earlier than through a regular work-up, meaning patients can be treated even earlier.
One patient featured in our story benefited from imaging such as this. He, a retired urologist, said that the metastases probably would not have been detected with a regular work-up.
Prior to his PSMA PET scan, which detected his lesions, standard imaging had detected no lesions. Many more milestones need to be reached before oligometastatic prostate cancer and other malignancies can be managed with curative intent as a standard of care, especially because this approach adds side effects and expenses.
This is where well-designed clinical trials come in. These are ongoing and use the most appropriate and up-to-date imaging, localized and systemic treatments to compare them with our current treatment approaches. The component usually being tested is localized radiation or surgery applied to the oligometastatic sites.
Ultimately, the goal needs to be an improvement in survival or an improved quality of life.
Debu Tripathy, M.D.
Professor of Medicine, Chief, Department of Breast Medical Oncology
The University of Texas MD Anderson Cancer Center
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