Recent advances in the management of synchronous oligometastatic prostate cancer (PC)
highlight the potential of combining local and systemic therapies. However, there
is growing interest in metastasis-directed therapy (MDT) in this setting. When all
modalities are combined, this is referred as "total eradication of tumour" (TET) or
"full monty treatment" (FMT). Retrospective studies have revealed promising outcomes
with approaches such as cytoreductive radical prostatectomy or radiotherapy alongside
MDT and combination systemic therapy. Multiple studies have demonstrated a significant
proportion of cases with undetectable prostate-specific antigen and noncastrate testosterone,
while one comparative trial (± MDT) revealed some evidence of an overall survival
benefit. Results from the prospective trials indicate the feasibility and effectiveness
of this intensive treatment strategy, with biochemical remission and disease-free
states achieved in a significant proportion of cases. Overall, limitations persist,
including a reliance on conventional imaging in all studies and the absence of long-term
prospective data. Ongoing trials will provide definitive insights into the treatment
efficacy and safety of TET/FMT. PATIENT SUMMARY: For patients with a new diagnosis
of prostate cancer with only few metastases, cancer control results after treatment
with local therapy, hormonal agents, and treatment targeted to all metastatic sites
are promising. Further clinical trials of this approach with the inclusion of new
scan techniques are eagerly awaited.
