What type of surgery, radiotherapy or chemotherapy should be employed?”1(p3-4) So what has changed in the past 50 years? These questions have lots of significance in history. In the first definitive treatise on low-volume metastatic cancer by Philip Rubin and Jerold Green, published in 1968 and entitled Solitary Metastases, the authors remark that “all too frequently, a solitary metastasis is an illusion rather than a reality.With subsequent medical advancements in staging—namely, imaging, and new metastasis-directed therapies such as stereotactic ablative radiotherapy—this formerly illusory oligometastatic state has again become an area of intense interest by cancer physicians.
As originally hypothesized by Hellman and Weichselbaum, the oligometastatic state is juxtaposed at an intermediate position along the spectrum of cancer progression where local therapies may not only alter their natural history, but also cure men with this metastatic disease state. We now have randomized clinical trial confirmation that local therapies can prolong the progression-free survival of patients with three or fewer metastases after first-line systemic therapy for NSCLC. To expound upon their work, we would like to highlight what we believe are key future outstanding clinical and biologic questions that will be important in the field of hormone-sensitive oligometastatic prostate cancer.
However, we are also optimistic that with the data from such prospective trials and efforts like the Movember Global Action Plan 6 initiative and others, we will have more knowledge to benefit these men with oligometastatic prostate cancer in the near future.