Oligometastatic Prostate Cancer : Basic Royal
Rapid improvements in medical technology are forcing us to rethink our traditional approach to early metastatic prostate cancer. PSMA scans are now widely available. These scans detect prostate cancer at much lower PSA levels than any other scan previously used for prostate cancer. These new scans enable the use of spot radiation administered to metastatic sites.
Historical experience with older, less accurate scan indicated that that men with early metastases probably had additional undetected microscopic metastases in other areas of the body and attempts to cure such patients by simply treating the visible metastases will fail, since the untreated microscopic cancers will eventually grow larger, leading to cancer recurrence. Countering this pessimistic view are the results of recent studies showing that aggressive treatment directed at all the visible metastases can lead to durable remissions. Studies show that durable remissions are more common if metastasis-focused treatment is combined with systemic treatment, which is active against undetected microscopic metastases. However, all these studies were performed before the advent of modern PSMA-PET technology. PSMA scans are so superior to previously available technology that it may be that in certain cases no further microscopic metastatic disease exists. In other words, some men with a limited number of PSMA – detected metastases can be cured with lesion-directed radiation alone.
ABOUT THE AUTHOR
Jeffrey Turner, MD is a board-certified internist and medical oncologist specializing full time in prostate cancer since 2009. Dr. Turner is an active member of the American Society of Clinical Oncology, American Society of Hematology, and American College of Physicians-Internal Medicine. He was a research associate at UCLA in infectious diseases and molecular biology. He then earned his medical degree in Canada at Memorial University of Newfoundland. He completed his internal medicine residency at the University of British Columbia and fellowship in medical oncology at the Medical University of South Carolina.