Opinion: Metastasis-Directed Therapy May Enhance Disease Control in Oligometastatic Prostate Cancer

Patients with metastatic cancer often ask their oncology team whether local treatments like surgery or radiation could help control their disease, either alongside or instead of systemic therapy. Answering this question can be complex, as the role of local therapy depends on factors such as the number, location, and extent of metastases. However, growing evidence suggests that metastasis-directed therapy (MDT) may improve outcomes in certain patients, making it an important area of ongoing research.

Amanda Brink, DNP, APRN, FNP-BC, AOCNP

Metastasis-Directed Therapy in Oligometastatic Prostate Cancer

In a recent abstract presented at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Tang et al. reported that metastasis-directed therapy (MDT) for oligometastatic prostate cancer, a stage in which cancer has spread to a limited number of distant sites, has shown a progression-free survival (PFS) benefit in multiple phase 2 randomized clinical trials. However, its impact on long-term outcomes, such as overall survival (OS), remains uncertain. The WOLVERINE meta-analysis pooled individual patient data from all published randomized clinical trials evaluating MDT in oligometastatic prostate cancer to provide a more comprehensive assessment of its efficacy.¹

The analysis included five trials—STOMP (NCT01558427), ORIOLE (NCT02680587), ARTO (NCT03449719), SABR-COMET (NCT01446744), and EXTEND (NCT03599765)—comparing MDT plus standard-of-care (SOC) therapy to SOC alone. A total of 472 patients were analyzed, with a median follow-up of 41 months. The majority had castration-sensitive prostate cancer (CSPC), and most were treated with androgen deprivation therapy (ADT), with or without androgen receptor pathway inhibitors (ARPIs).

The results showed that MDT significantly delayed disease progression in patients with oligometastatic prostate cancer. Patients who received MDT had longer PFS and radiographic PFS (rPFS). Additionally, MDT helped delay the development of castration-resistant prostate cancer (CRPC).

The pooled hazard ratios (HRs) from multiple statistical models consistently showed a strong benefit with MDT. Specifically, MDT reduced the risk of disease progression by 55% (HR, 0.45; P < .0001) and lowered the risk of developing castration-resistant disease by 42% (HR, 0.58; P = .019). In practical terms, this means that patients who received MDT were significantly more likely to remain stable on their current treatments for a longer period compared to those who received standard therapy alone.

OS was high in both groups, with more than 92% and 87% of patients still alive at 3 and 4 years, respectively. While MDT was associated with a trend toward improved OS, the statistical significance was borderline (HR, 0.63-0.64; P = .051),.

Importantly, the advantages of MDT were seen across different types of patients, including both those whose with de novo and those with metachronous metastases. The benefit was also consistent regardless of whether patients had CSPC or more advanced CRPC. This suggests that MDT may be a valuable treatment approach for a broad range of patients with oligometastatic prostate cancer.

Nursing Considerations

The WOLVERINE meta-analysis reinforces the role of MDT in delaying disease progression in patients with oligometastatic prostate cancer. While the OS benefit remains uncertain, MDT significantly improves PFS and delays the onset of CRPC. These findings support incorporating MDT into the treatment approach for select patients.

For oncology nurses, these results highlight the importance of patient education and advocacy. Nurses can more confidently discuss the potential benefits of MDT when patients inquire about treatment options and can also proactively identify and advocate for patients who may be candidates for MDT. Additionally, they play a key role in helping patients understand the goals of MDT—prolonging disease control and potentially delaying the need for more intensive systemic therapy.

Staying informed about emerging data on MDT allows oncology nurses to guide patients through complex treatment decisions and facilitate discussions with an interdisciplinary team of medical oncologists, radiation oncologists, and surgeons to improve patient care.

Reference

1. Tang C, et al. World-wide oligometastatic prostate cancer (omPC) meta-analysis leveraging individual patient data (IPD) from randomized trials (WOLVERINE): An analysis from the X-MET collaboration. J Clin Oncol. 2025;43(5 Suppl):15. doi:10.1200/JCO.2025.43.5_suppl.15