Recommendations for RT in Oligometastatic PCa: an ESTRO-ACROP Delphi consensus

Recommendations for Radiation Therapy in Oligometastatic Prostate Cancer: an ESTRO-ACROP Delphi consensus (2022, Full Text)

Guidelines from a European RO group

"Highlights

• PSMA PET imaging is the preferred staging and restaging imaging modality for oligometastatic, oligorecurrent and oligoprogressive prostate cancer patients.

• Metastasis-directed radiotherapy (MDRT) may be considered for patients diagnosed with up to 5 lymph nodal, bone, or visceral metastases in all disease settings.

• Systemic therapy with loco-regional irradiation and MDRT of all metastatic lesions is the preferred option for synchronous de novo oligometastatic hormone-sensitive patients.

• MDRT of all lesions without switch of systemic therapy is recommended for patients with oligoprogressive castration-resistant prostate cancer.


Abstract

Background and purpose
Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospective randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices.

Material and methods
A European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee consisting of radiation oncologists’ experts in prostate cancer was asked to answer a dedicated questionnaire, including 41 questions on the main controversial issues with regard to oligometastatic prostate cancer.

Results
The panel achieved consensus on patient selection and routine use of prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging as preferred staging and restaging imaging. MDT strategies are recommended in the de novo oligometastatic, oligorecurrent and oligoprogressive disease setting for nodal, bone and visceral metastases. Radiation therapy doses, volumes and techniques were discussed and commented.

Conclusion
These recommendations have the purpose of providing standardization and consensus to optimize the radiotherapy treatment of oligometastatic prostate cancer until mature results of randomized trials are available."

See the Full Text for details.

Trailguy, I'm glad you've had success with your treatment up to now, (As you may have noticed, an Oriole paper in JAMA is cited as ref. #11 in the review). I wish you continued great PSA readings!

Djin