urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2020-8-2-55-66urovest-331Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS ARTICLEОлигометастатический рак предстательной железы: диагностика и предварительные результаты лучевого леченияOligometastatic prostate cancer: diagnosis and preliminary results of radiation therapyhttps://orcid.org/0000-0001-5117-6143ДжабаровФ. Р.DzhabarovF. R.

Фархад Расимович Джабаров ‒ д.м.н., доцент; и.о. заведующего кафедры лучевой диагностики ФПК и ППС

 

Farhad R. Dzhabarov ‒ M.D., Dr.Sc.(M); Assoc.Prof. (Docent), Acting Head, Dept. of Radiation Diagnostics

d-farik@yandex.ruhttps://orcid.org/0000-0002-6853-766XАльникинА. Б.AlnikinA. B.

Александр Борисович Альникин – к.м.н.; доцент кафедры хирургических болезней №2, главный врач Kлиники

Alexander B. Alnikin ‒ M.D., Cand.Sc.(M); Assoc.Prof., Dept. of Surgical Diseases No.2

Chief Medical Officer

alnikin_ab@rostgmu.ruhttps://orcid.org/0000-0002-6742-0670ТолмачевВ. Г.TolmachevV. G.

Владимир Генрихович Толмачев – ассистент кафедры лучевой диагностики ФПК и ППС 

врач-радиотерапевт отделения радиотерапии

Vladimir G. Tolmachev – M.D.; Assist., Dept. of Radiation Diagnostics

Radiotherapist, Dept. of Radiotherapy

speacker@mail.ruФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov State Medical UniversityRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России; ГБУ РО «Онкологический диспансер»РоссияRostov State Medical University; Rostov-on-Don Regional Oncology CenterRussian Federation202030062020825566Copyright © Джабаров Ф.Р., Альникин А.Б., Толмачев В.Г., 20202020Джабаров Ф.Р., Альникин А.Б., Толмачев В.Г.Dzhabarov F.R., Alnikin A.B., Tolmachev V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/331

Рак предстательной железы (РПЖ) остаётся одной из наиболее актуальных проблем современной онкологии, что, прежде всего, связано с высоким уровнем распространённости данной патологии. Появление метастазов, безусловно, является неблагоприятным фактором течения заболевания. Однако метастатическое поражение при РПЖ — это очень гетерогенное состояние. «Олигометастатический рак» рассматривается как особое заболевание с другими свойствами опухоли, как переходное состояние между локализованной и диссеминированной стадией заболевания. Диагностика олигометастатического рака представляет собой крайне сложную задачу, связанную с точным определением количества и локализации метастазов, как гематогенных, так и лимфогенных, что в свою очередь требует дифференцировки с регионарным поражением лимфоузлов местнораспространённого опухолевого процесса. В настоящее время широко используются для диагностики метастатического поражения лимфоузлов радиотрейсеры, имеющие высокую специфичность при раке предстательной железы, нацеленные на простат-специфический мембранный антиген (PSMA; также известный как глутаматкарбоксипептидаза), такие как 11C-холин, 18F-фторэтилхолин, 68Ga.

Проведено лечение 9 пациентов c раком предстательной железы и олигометастатическим поражением. Всем пациентам проведена дистанционная лучевая терапия. Суммарная очаговая доза на лимфоколлектор визуализированного поражённого лимфоузла составила 44,0 изоГр. Суммарная очаговая доза с учётом методики проведения лучевого лечения «поля в поле» на лимфоузел составила 70,0 изоГр. Через 6 недель после завершения курса лучевой терапии и нивелирования остроты побочных реакций у всех пациентов достигнуто снижение уровня простатспецифического антигена до уровня ниже 1,0 нг/мл. Признаков рецидива заболевания не обнаружено ни у одного из пролеченных пациентов.

Prostate cancer (PCa) remains one of the most pressing problems of modern oncology, which is primarily associated with the high prevalence of this pathology. Of course, the appearance of metastases is an unfavourable factor in the course of the disease. However, PCa metastases is a very heterogeneous condition. «Oligometastatic cancer» is considered as a special disease with other properties of the tumour, i.e. as a transitional state between the localized and disseminated stage of the disease. Diagnosis of oligometastatic cancer is an extremely difficult task associated with the accurate determination of the number and localization of metastases, both hematogenous and lymphogenous, which in turn requires differentiation with regional lesions of the lymph nodes of a locally advanced tumour process. Currently, radiotracers are widely used to diagnose metastatic lymph node lesions that have high specificity for PCa, targeting a prostate-specific membrane antigen (PSMA; also known as glutamate carboxypeptidase), such as 11C-choline, 18F-fluoroethylcholine, 68Ga.

9 patients with prostate cancer with the oligometastatic lesion were treated. All patients underwent external beam radiation therapy. Total focal dose on the visualized lymph collector of the affected lymph node amounted to 44.0 Gr. Total focal dose with the method of radiotherapy treatment «field in the field» on the node 70.0 Gr. In all patients, a PSA was reduced to a level below 1.0 ng/ml 6 weeks after completion of the course of radiation therapy and levelling the severity of adverse reactions. None of the treated patients showed signs of a PCa recurrence.

рак предстательной железыолигометатстазыединичный метастазПЭТ-СКТлучевая терапияфракционирование дневной дозыprostate canceroligometatstasessingle metastasisPET-SCTradiation therapydaily dose fractionationReferencesЗлокачественные новообразования в России в 2018 году (заболеваемость и смертность). Под ред. Каприна А.Д., Старинского В.В., Петровой Г.В. М.: МНИОИ им. П.А. Герцена ‒ филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2019.Zlokachestvennye novoobrazovanija v Rossii v 2018 godu (zabolevaemost’ i smertnost’). Pod red. Kaprina A.D., Starinskogo V.V., Petrovoj G.V. M.: MNIOI im. P.A. Gercena ‒ filial FGBU «NMIC radiologii» Minzdrava Rossii, 2019. (In Russ.).Рак предстательной железы: протеомика, геномика, хирургия. Науч. ред. Коган М. И., Пушкарь Д.Ю. М.: ООО «ИД «АБВ-пресс»; 2019. ISBN 978 5 903018 64 2Prostate cancer: proteomics, genomics, surgery. Scientific ed. Kogan M.I., Pushkar D.Yu. Moscow: Publishing House ABV-Press; 2019. (In Russ.). ISBN 978 5 903018 64 2Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10. https://doi.org/10.1200/JCO.1995.13.1.8Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10. https://doi.org/10.1200/JCO.1995.13.1.8Алексеев Б.Я., Нюшко К.М., Крашенинников А.А., Сафронова Е.Ю., Сергиенко С.А., Калпинский А.С., Воробьев Н.В., Каприн А.Д. Методы диагностики и лечения олигометастазов у больных раком предстательной железы с прогрессированием заболевания после проведенного радикального лечения. Онкоурология. 2016;12(2):64‒73. https://doi.org/10.17650/1726-9776-2016-12-2-64-73Alekseev B.Y., Nyushko K.M., Krasheninnikov A.A., Safronova E.Y., Sergienko S.A., Kalpinskiy A.S., Vorob’ev N.V., Kaprin A.D. Methods for the diagnosis and treatment of oligometastases in patients with prostate cancer and progressive disease after radical treatment. Cancer Urology. 2016;12(2):64‒73. (In Russ.). https://doi.org/10.17650/1726-9776-2016-12-2- 64-73Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget. 2015;6(11):8491‒8524. https://doi.org/10.18632/oncotarget.3455Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget. 2015;6(11):8491‒8524. https://doi.org/10.18632/oncotarget.3455Khoo V. Is there another bite of the cherry? The case for radical local therapy for oligometastatic disease in prostate cancer. Eur Urol. 2016;69(1):13‒14. https://doi.org/10.1016/j. eururo.2015.07.073Khoo V. Is there another bite of the cherry? The case for radical local therapy for oligometastatic disease in prostate cancer. Eur Urol. 2016;69(1):13‒14. https://doi.org/10.1016/j. eururo.2015.07.073Evangelista L, Briganti A, Fanti S, Joniau S, Reske S, Schiavina R, Stief C, Thalmann GN, Picchio M. New clinical indications for (18)F/(11)C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature. Eur Urol. 2016;70(1):161‒175. https://doi.org/10.1016/j.eururo.2016.01.029Evangelista L, Briganti A, Fanti S, Joniau S, Reske S, Schiavina R, Stief C, Thalmann GN, Picchio M New Clinical Indications for (18)F/(11)C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature. Eur Urol. 2016;70(1):161‒175. https://doi.org/10.1016/j.eururo.2016.01.029Tamoto E, Tada M, Murakawa K, Takada M, Shindo G, Teramoto K, Matsunaga A, Komuro K, Kanai M, Kawakami A, Fujiwara Y, Kobayashi N, Shirata K, Nishimura N, Okushiba S, Kondo S, Hamada J, Yoshiki T, Moriuchi T, Katoh H. Geneexpression profile changes correlated with tumor progression and lymph node metastasis in esophageal cancer. Clin Cancer Res. 2004;10(11):3629‒3638. https://doi.org/10.1158/1078- 0432.CCR-04-0048Tamoto E, Tada M, Murakawa K, Takada M, Shindo G, Teramoto K, Matsunaga A, Komuro K, Kanai M, Kawakami A, Fujiwara Y, Kobayashi N, Shirata K, Nishimura N, Okushiba S, Kondo S, Hamada J, Yoshiki T, Moriuchi T, Katoh H. Gene-expression profile changes correlated with tumor progression and lymph node metastasis in esophageal cancer. Clin Cancer Res. 2004;10(11):3629‒3638. https://doi.org/10.1158/1078-0432.CCR-04-0048Wuttig D, Baier B, Fuessel S, Meinhardt M, Herr A, Hoefling C, Toma M, Grimm MO, Meye A, Rolle A, Wirth MP. Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease-free interval and the number of metastases per patient. Int J Cancer. 2009;125(2):474‒482. https://doi.org/10.1002/ijc.24353Wuttig D, Baier B, Fuessel S, Meinhardt M, Herr A, Hoefling C, Toma M, Grimm MO, Meye A, Rolle A, Wirth MP. Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease-free interval and the number of metastases per patient. Int J Cancer. 2009;125(2):474‒482. https://doi.org/10.1002/ijc.24353Lussier YA, Xing HR, Salama JK, Khodarev NN, Huang Y, Zhang Q, Khan SA, Yang X, Hasselle MD, Darga TE, Malik R, Fan H, Perakis S, Filippo M, Corbin K, Lee Y, Posner MC, Chmura SJ, Hellman S, Weichselbaum RR. MicroRNA expression characterizes oligometastasis(es). PLoS One. 2011;6(12):e28650. https://doi.org/10.1371/journal.pone.0028650Lussier YA, Xing HR, Salama JK, Khodarev NN, Huang Y, Zhang Q, Khan SA, Yang X, Hasselle MD, Darga TE, Malik R, Fan H, Perakis S, Filippo M, Corbin K, Lee Y, Posner MC, Chmura SJ, Hellman S, Weichselbaum RR. MicroRNA expression characterizes oligometastasis(es). PLoS One. 2011;6(12):e28650. https://doi.org/10.1371/journal.pone.0028650Rubin P, Brasacchio R, Katz A. Solitary metastases: illusion versus reality. Semin Radiat Oncol. 2006;16(2):120‒130. https://doi.org/10.1016/j.semradonc.2005.12.007Rubin P, Brasacchio R, Katz A. Solitary metastases: illusion versus reality. Semin Radiat Oncol. 2006;16(2):120‒130. https://doi.org/10.1016/j.semradonc.2005.12.007Bayne CE, Williams SB, Cooperberg MR, Gleave ME, Graefen M, Montorsi F, Novara G, Smaldone MC, Sooriakumaran P, Wiklund PN, Chapin BF. Treatment of the primary tumor in metastatic prostate cancer: current concepts and future perspectives. Eur Urol. 2016;69(5):775‒787. https://doi.org/10.1016/j.eururo.2015.04.036Bayne CE, Williams SB, Cooperberg MR, Gleave ME, Graefen M, Montorsi F, Novara G, Smaldone MC, Sooriakumaran P, Wiklund PN, Chapin BF. Treatment of the primary tumor in metastatic prostate cancer: current concepts and future perspectives. Eur Urol. 2016;69(5):775‒787. https://doi.org/10.1016/j.eururo.2015.04.036Soloway MS, Hardeman SW, Hickey D, Raymond J, Todd B, Soloway S, Moinuddin M. Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer. 1988;61(1):195‒202. https://doi.org/10.1002/1097-0142(19880101)61:13.0.co;2-ySoloway MS, Hardeman SW, Hickey D, Raymond J, Todd B, Soloway S, Moinuddin M. Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer. 1988;61(1):195‒202. https://doi.org/10.1002/1097-0142(19880101)61:13.0.co;2-ySingh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, Messing E, Okunieff P. Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol Biol Phys. 2004;58(1):3‒10. https://doi.org/10.1016/s0360-3016(03)01442-1Singh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, Messing E, Okunieff P. Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol Biol Phys. 2004;58(1):3‒10. https://doi.org/10.1016/s0360-3016(03)01442-1Tabata K, Niibe Y, Satoh T, Tsumura H, Ikeda M, Minamida S, Fujita T, Ishii D, Iwamura M, Hayakawa K, Baba S. Radiotherapy for oligometastases and oligo-recurrence of bone in prostate cancer. Pulm Med. 2012;2012:541656. https://doi.org/10.1155/2012/541656Tabata K, Niibe Y, Satoh T, Tsumura H, Ikeda M, Minamida S, Fujita T, Ishii D, Iwamura M, Hayakawa K, Baba S. Radiotherapy for oligometastases and oligo-recurrence of bone in prostate cancer. Pulm Med. 2012;2012:541656. https://doi.org/10.1155/2012/541656Ahmed KA, Barney BM, Davis BJ, Park SS, Kwon ED, Olivier KR. Stereotactic body radiation therapy in the treatment of oligometastatic prostate cancer. Front Oncol. 2013;2:215. https://doi.org/10.3389/fonc.2012.00215Ahmed KA, Barney BM, Davis BJ, Park SS, Kwon ED, Olivier KR. Stereotactic body radiation therapy in the treatment of oligometastatic prostate cancer. Front Oncol. 2013;2:215. https://doi.org/10.3389/fonc.2012.00215Ost P, Decaestecker K, Lambert B, Fonteyne V, Delrue L, Lumen N, Ameye F, De Meerleer G. Prognostic factors influencing prostate cancer-specific survival in non-castrate patients with metastatic prostate cancer. Prostate. 2014;74(3):297‒305. https://doi.org/10.1002/pros.22750Ost P, Decaestecker K, Lambert B, Fonteyne V, Delrue L, Lumen N, Ameye F, De Meerleer G. Prognostic factors influencing prostate cancer-specific survival in noncastrate patients with metastatic prostate cancer. Prostate. 2014;74(3):297‒305. https://doi.org/10.1002/pros.22750Gandaglia G, Karakiewicz PI, Briganti A, Passoni NM, Schiffmann J, Trudeau V, Graefen M, Montorsi F, Sun M. Impact of the site of metastases on survival in patients with metastatic prostate cancer. Eur Urol. 2015;68(2):325‒334. https://doi.org/10.1016/j.eururo.2014.07.020Gandaglia G, Karakiewicz PI, Briganti A, Passoni NM, Schiffmann J, Trudeau V, Graefen M, Montorsi F, Sun M. Impact of the site of metastases on survival in patients with metastatic prostate cancer. Eur Urol. 2015;68(2):325‒334. https://doi.org/10.1016/j.eururo.2014.07.020Berkovic P, De Meerleer G, Delrue L, Lambert B, Fonteyne V, Lumen N, Decaestecker K, Villeirs G, Vuye P, Ost P. Salvage stereotactic body radiotherapy for patients with limited prostate cancer metastases: deferring androgen deprivation therapy. Clin Genitourin Cancer. 2013;11(1):27‒32. https://doi.org/10.1016/j.clgc.2012.08.003Berkovic P, De Meerleer G, Delrue L, Lambert B, Fonteyne V, Lumen N, Decaestecker K, Villeirs G, Vuye P, Ost P. Salvage stereotactic body radiotherapy for patients with limited prostate cancer metastases: deferring androgen deprivation therapy. Clin Genitourin Cancer. 2013;11(1):27‒32. https://doi.org/10.1016/j.clgc.2012.08.003Decaestecker K, De Meerleer G, Lambert B, Delrue L, Fonteyne V, Claeys T, De Vos F, Huysse W, Hautekiet A, Maes G, Ost P. Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence. Radiat Oncol. 2014;9:135. https://doi.org/10.1186/1748-717X-9-135Decaestecker K, De Meerleer G, Lambert B, Delrue L, Fonteyne V, Claeys T, De Vos F, Huysse W, Hautekiet A, Maes G, Ost P. Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence. Radiat Oncol. 2014;9:135. https://doi.org/10.1186/1748-717X-9-135Ost P, Jereczek-Fossa BA, As NV, Zilli T, Muacevic A, Olivier K, Henderson D, Casamassima F, Orecchia R, Surgo A, Brown L, Tree A, Miralbell R, De Meerleer G. Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multiinstitutional analysis. Eur Urol. 2016;69(1):9‒12. https://doi.org/10.1016/j.eururo.2015.07.004Ost P, Jereczek-Fossa BA, As NV, Zilli T, Muacevic A, Olivier K, Henderson D, Casamassima F, Orecchia R, Surgo A, Brown L, Tree A, Miralbell R, De Meerleer G. Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multiinstitutional analysis. Eur Urol. 2016;69(1):9‒12. https://doi.org/10.1016/j.eururo.2015.07.004Evans JD, Morris LK, Zhang H, Cao S, Liu X, Mara KC, Stish BJ, Davis BJ, Mansfield AS, Dronca RS, Iott MJ, Kwon ED, Foote RL, Olivier KR, Dong H, Park SS. Prospective Immunophenotyping of CD8(+) T Cells and Associated Clinical Outcomes of Patients With Oligometastatic Prostate Cancer Treated With Metastasis-Directed SBRT. Int J Radiat Oncol Biol Phys. 2019;103(1):229‒240. https://doi.org/10.1016/j. ijrobp.2018.09.001Evans JD, Morris LK, Zhang H, Cao S, Liu X, Mara KC, Stish BJ, Davis BJ, Mansfield AS, Dronca RS, Iott MJ, Kwon ED, Foote RL, Olivier KR, Dong H, Park SS. Prospective Immunophenotyping of CD8(+) T Cells and Associated Clinical Outcomes of Patients With Oligometastatic Prostate Cancer Treated With Metastasis-Directed SBRT. Int J Radiat Oncol Biol Phys. 2019;103(1):229‒240. https://doi.org/10.1016/j.ijrobp.2018.09.001Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol. 2018;36(5):446‒453. https://doi.org/10.1200/JCO.2017.75.4853Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol. 2018;36(5):446‒453. https://doi.org/10.1200/JCO.2017.75.4853Phillips R, Shi WY, Deek M, Radwan N, Lim SJ, Antonarakis ES, Rowe SP, Ross AE, Gorin MA, Deville C, Greco SC, Wang H, Denmeade SR, Paller CJ, Dipasquale S, DeWeese TL, Song DY, Wang H, Carducci MA, Pienta KJ, Pomper MG, Dicker AP, Eisenberger MA, Alizadeh AA, Diehn M, Tran PT. Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial. JAMA Oncol. 2020;6(5):650–659. https://doi.org/10.1001/jamaoncol.2020.0147Phillips R, Shi WY, Deek M, Radwan N, Lim SJ, Antonarakis ES, Rowe SP, Ross AE, Gorin MA, Deville C, Greco SC, Wang H, Denmeade SR, Paller CJ, Dipasquale S, DeWeese TL, Song DY, Wang H, Carducci MA, Pienta KJ, Pomper MG, Dicker AP, Eisenberger MA, Alizadeh AA, Diehn M, Tran PT. Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial. JAMA Oncol. 2020;6(5):650–659. https://doi.org/10.1001/jamaoncol.2020.0147Gerard Morton, Penco Cheung, H.T. Chung, D. Vesprini, William Wai Chu, Stanley K Liu et al. Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys. 2019;105(1):E269‒E270. https://doi.org/10.1016/j.ijrobp.2019.06.1886Gerard Morton, Penco Cheung, H.T. Chung, D. Vesprini, William Wai Chu, Stanley K Liu et al. Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys. 2019;105(1):E269‒E270. https://doi.org/10.1016/j.ijrobp.2019.06.1886Tabata K, Niibe Y, Satoh T, Tsumura H, Ikeda M, Minamida S, Fujita T, Ishii D, Iwamura M, Hayakawa K, Baba S. Radiotherapy for oligometastases and oligo-recurrence of bone in prostate cancer. Pulm Med. 2012;2012:541656. https://doi.org/10.1155/2012/541656Tabata K, Niibe Y, Satoh T, Tsumura H, Ikeda M, Minamida S, Fujita T, Ishii D, Iwamura M, Hayakawa K, Baba S. Radiotherapy for oligometastases and oligo-recurrence of bone in prostate cancer. Pulm Med. 2012;2012:541656. https://doi.org/10.1155/2012/541656Schick U, Jorcano S, Nouet P, Rouzaud M, Vees H, Zilli T, Ratib O, Weber DC, Miralbell R. Androgen deprivation and high-dose radiotherapy for oligometastatic prostate cancer patients with less than five regional and/or distant metastases. Acta Oncol. 2013;52(8):1622‒1628. https://doi.org/10.3109/0284 186X.2013.764010Schick U, Jorcano S, Nouet P, Rouzaud M, Vees H, Zilli T, Ratib O, Weber DC, Miralbell R. Androgen deprivation and high-dose radiotherapy for oligometastatic prostate cancer patients with less than five regional and/or distant metastases. Acta Oncol. 2013;52(8):1622‒1628. https://doi.org/10.3109/0284 186X.2013.764010Ross AE, Hurley PJ, Tran PT, Rowe SP, Benzon B, Neal TO, Chapman C, Harb R, Milman Y, Trock BJ, Drake CG, Antonarakis ES. A pilot trial of pembrolizumab plus prostatic cryotherapy for men with newly diagnosed oligometastatic hormonesensitive prostate cancer. Prostate Cancer Prostatic Dis. 2020;23(1):184‒193. https://doi.org/10.1038/s41391-019- 0176-8Ross AE, Hurley PJ, Tran PT, Rowe SP, Benzon B, Neal TO, Chapman C, Harb R, Milman Y, Trock BJ, Drake CG, Antonarakis ES. A pilot trial of pembrolizumab plus prostatic cryotherapy for men with newly diagnosed oligometastatic hormonesensitive prostate cancer. Prostate Cancer Prostatic Dis. 2020;23(1):184‒193. https://doi.org/10.1038/s41391-019- 0176-8Lujan-Castilla PJ, Villaseñor-Navarro LF, Bautista-Hernandez Y, Nuñez-Guardado G, Villavicencio-Queijeiro MA, Rojas-Rivera A, Enriquez-Barrera M, Manzanilla-Garcia H, Marquez-Diaz C. Experiencia clínica con radioterapia de intensidad modulada (IMRT) en pacientes con cáncer de próstata [Clinical experience with intensity modulated radiation therapy (IMRT) in patients with prostate cancer]. Gaceta Mexicana de Oncologia. 2010;9(6):266‒275. (In Spanish).Lujan-Castilla PJ, Villaseñor-Navarro LF, Bautista-Hernandez Y, Nuñez-Guardado G, Villavicencio-Queijeiro MA, Rojas-Rivera A, Enriquez-Barrera M, Manzanilla-Garcia H, Marquez-Diaz C. Experiencia clínica con radioterapia de intensidad modulada (IMRT) en pacientes con cáncer de próstata [Clinical experience with intensity modulated radiation therapy (IMRT) in patients with prostate cancer]. Gaceta Mexicana de Oncologia. 2010;9(6):266‒275. (In Spanish).Karen A. Autio, James Andrew Eastham, Daniel Costin Danila, Susan F. Slovin, Michael J Morris, Wassim Abida, Vincent Paul Laudone, Karim A. Touijer, Anuradha Gopalan, Phillip Wong, Tracy Curley, Erica Simone Dayan, Lawrence P. Bellomo, Peter T. Scardino, Howard I Scher A phase II study combining ipilimumab and degarelix with or without radical prostatectomy (RP) in men with newly diagnosed metastatic noncastration prostate cancer (mNCPC) or biochemically recurrent (BR) NCPC. Journal of Clinical Oncology. 2017;35(6_ suppl):203‒203. https://doi.org/10.1200/JCO.2017.35.6_suppl.203Karen A. Autio, James Andrew Eastham, Daniel Costin Danila, Susan F. Slovin, Michael J Morris, Wassim Abida, Vincent Paul Laudone, Karim A. Touijer, Anuradha Gopalan, Phillip Wong, Tracy Curley, Erica Simone Dayan, Lawrence P. Bellomo, Peter T. Scardino, Howard I Scher A phase II study combining ipilimumab and degarelix with or without radical prostatectomy (RP) in men with newly diagnosed metastatic noncastration prostate cancer (mNCPC) or biochemically recurrent (BR) NCPC. Journal of Clinical Oncology. 2017;35(6_ suppl):203‒203. https://doi.org/10.1200/JCO.2017.35.6_suppl.203Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N; European Association of Urology. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65(1):124‒137. https://doi.org/10.1016/j.eururo.2013.09.046Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N; European Association of Urology. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65(1):124‒137. https://doi.org/10.1016/j.eururo.2013.09.046Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA. 2005;294(2):238‒244. https://doi.org/10.1001/jama.294.2.238Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA. 2005;294(2):238‒244. https://doi. org/10.1001/jama.294.2.238 33. Perlmutter MA, Lepor H. Androgen deprivation therapy in the treatment of advanced prostate cancer. Rev Urol. 2007;9(Suppl 1):S3-8. PMCID: PMC1831539.Perlmutter MA, Lepor H. Androgen deprivation therapy in the treatment of advanced prostate cancer. Rev Urol. 2007;9(Suppl 1):S3-8. PMCID: PMC1831539.James ND, Spears MR, Clarke NW, Dearnaley DP, Mason MD, Parker CC, Ritchie AW, Russell JM, Schiavone F, Attard G, de Bono JS, Birtle A, Engeler DS, Elliott T, Matheson D, O’Sullivan J, Pudney D, Srihari N, Wallace J, Barber J, Syndikus I, Parmar MK, Sydes MR; STAMPEDE Investigators. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial. JAMA Oncol. 2016;2(3):348‒357. https://doi.org/10.1001/jamaoncol.2015.4350James ND, Spears MR, Clarke NW, Dearnaley DP, Mason MD, Parker CC, Ritchie AW, Russell JM, Schiavone F, Attard G, de Bono JS, Birtle A, Engeler DS, Elliott T, Matheson D, O’Sullivan J, Pudney D, Srihari N, Wallace J, Barber J, Syndikus I, Parmar MK, Sydes MR; STAMPEDE Investigators. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial. JAMA Oncol. 2016;2(3):348‒357. https://doi.org/10.1001/jamaoncol.2015.4350Lin CC, Gray PJ, Jemal A, Efstathiou JA. Androgen deprivation with or without radiation therapy for clinically node-positive prostate cancer. J Natl Cancer Inst. 2015;107(7):djv119. https://doi.org/10.1093/jnci/djv119Lin CC, Gray PJ, Jemal A, Efstathiou JA. Androgen deprivation with or without radiation therapy for clinically node-positive prostate cancer. J Natl Cancer Inst. 2015;107(7):djv119. https://doi.org/10.1093/jnci/djv119Tward JD, Kokeny KE, Shrieve DC. Radiation therapy for clinically node-positive prostate adenocarcinoma is correlated with improved overall and prostate cancer-specific survival. Pract Radiat Oncol. 2013;3(3):234‒240. https://doi.org/10.1016/j.prro.2012.11.011Tward JD, Kokeny KE, Shrieve DC. Radiation therapy for clinically node-positive prostate adenocarcinoma is correlated with improved overall and prostate cancer-specific survival. Pract Radiat Oncol. 2013;3(3):234‒240. https://doi.org/10.1016/j.prro.2012.11.011Rusthoven CG, Carlson JA, Waxweiler TV, Raben D, Dewitt PE, Crawford ED, Maroni PD, Kavanagh BD. The impact of definitive local therapy for lymph node-positive prostate cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2014;88(5):1064‒1073. https://doi.org/10.1016/j. ijrobp.2014.01.008Rusthoven CG, Carlson JA, Waxweiler TV, Raben D, Dewitt PE, Crawford ED, Maroni PD, Kavanagh BD. The impact of definitive local therapy for lymph node-positive prostate cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2014;88(5):1064‒1073. https://doi.org/10.1016/j. ijrobp.2014.01.008Aoun F, Peltier A, van Velthoven R. A comprehensive review of contemporary role of local treatment of the primary tumor and/or the metastases in metastatic prostate cancer. Biomed Res Int. 2014;2014:501213. https://doi.org/10.1155/2014/501213Aoun F, Peltier A, van Velthoven R. A comprehensive review of contemporary role of local treatment of the primary tumor and/or the metastases in metastatic prostate cancer. Biomed Res Int. 2014;2014:501213. https://doi.org/10.1155/2014/501213Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini G, Karnes RJ, Roach M 3rd, Briganti A. Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2015;67(5):852‒863. https://doi.org/10.1016/j. eururo.2014.09.004Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini G, Karnes RJ, Roach M 3rd, Briganti A. Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2015;67(5):852‒863. https://doi.org/10.1016/j.eururo.2014.09.004von Eyben FE, Kairemo K. Meta-analysis of (11)C-choline and (18)F-choline PET/CT for management of patients with prostate cancer. Nucl Med Commun. 2014;35(3):221‒230. https://doi.org/10.1097/MNM.0000000000000040von Eyben FE, Kairemo K. Meta-analysis of (11)C-choline and (18)F-choline PET/CT for management of patients with prostate cancer. Nucl Med Commun. 2014;35(3):221‒230. https://doi.org/10.1097/MNM.0000000000000040Garcia JR, Moreno C, Valls E, Cozar P, Bassa P, Soler M, Alvarez-Moro FJ, Moragas M, Riera E. Rendimiento diagnóstico de la gammagrafía ósea y la PET/TAC con (11)C-colina en la detección de metástasis óseas en pacientes con recidiva bioquímica de cáncer de próstata [Diagnostic performance of bone scintigraphy and (11)C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer]. Rev Esp Med Nucl Imagen Mol. 2015;34(3):155‒161. (In Spanish). https://doi.org/10.1016/j. remn.2014.08.001Garcia JR, Moreno C, Valls E, Cozar P, Bassa P, Soler M, AlvarezMoro FJ, Moragas M, Riera E. Rendimiento diagnóstico de la gammagrafía ósea y la PET/TAC con (11)C-colina en la detección de metástasis óseas en pacientes con recidiva bioquímica de cáncer de próstata [Diagnostic performance of bone scintigraphy and (11)C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer]. Rev Esp Med Nucl Imagen Mol. 2015;34(3):155‒161. (In Spanish). https://doi.org/10.1016/j. remn.2014.08.001Gabriele D, Collura D, Oderda M, Stura I, Fiorito C, Porpiglia F, Terrone C, Zacchero M, Guiot C, Gabriele P. Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database. World J Urol. 2016;34(4):517‒523. https://doi.org/10.1007/s00345-015-1669-2Gabriele D, Collura D, Oderda M, Stura I, Fiorito C, Porpiglia F, Terrone C, Zacchero M, Guiot C, Gabriele P. Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database. World J Urol. 2016;34(4):517‒523. https://doi.org/10.1007/s00345-015-1669-2Mohler JL, Armstrong AJ, Bahnson RR, D’Amico AV, Davis BJ, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Kane CJ, Kawachi MH, Kuettel M, Lee RJ, Meeks JJ, Penson DF, Plimack ER, Pow-Sang JM, Raben D, Richey S, Roach M 3rd, Rosenfeld S, Schaeffer E, Skolarus TA, Small EJ, Sonpavde G, Srinivas S, Strope SA, Tward J, Shead DA, Freedman-Cass DA. Prostate Cancer, Version 1.2016. J Natl Compr Canc Netw. 2016;14(1):19‒30. https://doi.org/10.6004/jnccn.2016.0004Mohler JL, Armstrong AJ, Bahnson RR, D’Amico AV, Davis BJ, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Kane CJ, Kawachi MH, Kuettel M, Lee RJ, Meeks JJ, Penson DF, Plimack ER, Pow-Sang JM, Raben D, Richey S, Roach M 3rd, Rosenfeld S, Schaeffer E, Skolarus TA, Small EJ, Sonpavde G, Srinivas S, Strope SA, Tward J, Shead DA, Freedman-Cass DA. Prostate Cancer, Version 1.2016. J Natl Compr Canc Netw. 2016;14(1):19‒30. https://doi.org/10.6004/jnccn.2016.0004Schirrmeister H, Guhlmann A, Elsner K, Kotzerke J, Glatting G, Rentschler M, Neumaier B, Träger H, Nüssle K, Reske SN. Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET. J Nucl Med. 1999;40(10):1623‒1629. PMID: 10520701.Schirrmeister H, Guhlmann A, Elsner K, Kotzerke J, Glatting G, Rentschler M, Neumaier B, Träger H, Nüssle K, Reske SN. Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET. J Nucl Med. 1999;40(10):1623‒1629. PMID: 10520701.Poulsen MH, Petersen H, Høilund-Carlsen PF, Jakobsen JS, Gerke O, Karstoft J, Steffansen SI, Walter S. Spine metastases in prostate cancer: comparison of technetium-99m-MDP whole-body bone scintigraphy, [(18) F]choline positron emission tomography(PET)/computed tomography (CT) and [(18) F]NaF PET/CT. BJU Int. 2014;114(6):818‒823. https://doi.org/10.1111/bju.12599Poulsen MH, Petersen H, Høilund-Carlsen PF, Jakobsen JS, Gerke O, Karstoft J, Steffansen SI, Walter S. Spine metastases in prostate cancer: comparison of technetium-99m-MDP whole-body bone scintigraphy, [(18) F]choline positron emission tomography(PET)/computed tomography (CT) and [(18) F]NaF PET/CT. BJU Int. 2014;114(6):818‒823. https://doi.org/10.1111/bju.12599Apolo AB, Lindenberg L, Shih JH, Mena E, Kim JW, Park JC, Alikhani A, McKinney YY, Weaver J, Turkbey B, Parnes HL, Wood LV, Madan RA, Gulley JL, Dahut WL, Kurdziel KA, Choyke PL. Prospective Study Evaluating Na18F PET/CT in Predicting Clinical Outcomes and Survival in Advanced Prostate Cancer. J Nucl Med. 2016;57(6):886‒892. https://doi.org/10.2967/jnumed.115.166512Apolo AB, Lindenberg L, Shih JH, Mena E, Kim JW, Park JC, Alikhani A, McKinney YY, Weaver J, Turkbey B, Parnes HL, Wood LV, Madan RA, Gulley JL, Dahut WL, Kurdziel KA, Choyke PL. Prospective Study Evaluating Na18F PET/CT in Predicting Clinical Outcomes and Survival in Advanced Prostate Cancer. J Nucl Med. 2016;57(6):886‒892. https://doi.org/10.2967/jnumed.115.166512Cho SY, Szabo Z. Molecular imaging of urogenital diseases. Semin Nucl Med. 2014;44(2):93‒109. https://doi.org/10.1053/j. semnuclmed.2013.10.008Cho SY, Szabo Z. Molecular imaging of urogenital diseases. Semin Nucl Med. 2014;44(2):93‒109. https://doi.org/10.1053/j.semnuclmed.2013.10.008van Leeuwen PJ, Stricker P, Hruby G, Kneebone A, Ting F, Thompson B, Nguyen Q, Ho B, Emmett L. (68) Ga-PSMA has a high detection rate of prostate cancer recurrence outside the prostatic fossa in patients being considered for salvage radiation treatment. BJU Int. 2016;117(5):732‒739. https://doi.org/10.1111/bju.13397van Leeuwen PJ, Stricker P, Hruby G, Kneebone A, Ting F, Thompson B, Nguyen Q, Ho B, Emmett L. (68) Ga-PSMA has a high detection rate of prostate cancer recurrence outside the prostatic fossa in patients being considered for salvage radiation treatment. BJU Int. 2016;117(5):732‒739. https://doi.org/10.1111/bju.13397Maurer T, Eiber M, Schwaiger M, Gschwend JE. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol. 2016;13(4):226‒235. https://doi.org/10.1038/nrurol.2016.26Maurer T, Eiber M, Schwaiger M, Gschwend JE. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol. 2016;13(4):226‒235. https://doi.org/10.1038/nrurol.2016.26Abrahamsson PA. Potential benefits of intermittent androgen suppression therapy in the treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2010;57(1):49‒59. https://doi.org/10.1016/j.eururo.2009.07.049Abrahamsson PA. Potential benefits of intermittent androgen suppression therapy in the treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2010;57(1):49‒59. https://doi.org/10.1016/j.eururo.2009.07.049Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N; European Association of Urology. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65(2):467‒479. https://doi.org/10.1016/j.eururo.2013.11.002Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N; European Association of Urology. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65(2):467‒479. https://doi.org/10.1016/j.eururo.2013.11.002Attard G, Sydes MR, Mason MD, Clarke NW, Aebersold D, de Bono JS, Dearnaley DP, Parker CC, Ritchie AW, Russell JM, Thalmann G, Cassoly E, Millman R, Matheson D, Schiavone F, Spears MR, Parmar MK, James ND. Combining enzalutamide with abiraterone, prednisone, and androgen deprivation therapy in the STAMPEDE trial. Eur Urol. 2014;66(5):799‒802. https://doi.org/10.1016/j.eururo.2014.05.038Attard G, Sydes MR, Mason MD, Clarke NW, Aebersold D, de Bono JS, Dearnaley DP, Parker CC, Ritchie AW, Russell JM, Thalmann G, Cassoly E, Millman R, Matheson D, Schiavone F, Spears MR, Parmar MK, James ND. Combining enzalutamide with abiraterone, prednisone, and androgen deprivation therapy in the STAMPEDE trial. Eur Urol. 2014;66(5):799‒802. https://doi.org/10.1016/j.eururo.2014.05.038Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, Wong YN, Hahn N, Kohli M, Cooney MM, Dreicer R, Vogelzang NJ, Picus J, Shevrin D, Hussain M, Garcia JA, DiPaola RS. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med. 2015;373(8):737‒746. https://doi.org/10.1056/NEJMoa1503747Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, Wong YN, Hahn N, Kohli M, Cooney MM, Dreicer R, Vogelzang NJ, Picus J, Shevrin D, Hussain M, Garcia JA, DiPaola RS. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med. 2015;373(8):737‒746. https://doi.org/10.1056/NEJMoa1503747Muacevic A, Kufeld M, Rist C, Wowra B, Stief C, Staehler M. Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer. Urol Oncol. 2013;31(4):455‒460. https://doi.org/10.1016/j.urolonc.2011.02.023Muacevic, Kufeld M, Rist C, Wowra B, Stief C, Staehler M. Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer. Urol Oncol. 2013;31(4):455‒460. https://doi.org/10.1016/j.urolonc.2011.02.023Muacevic, Kufeld M, Rist C, Wowra B, Stief C, Staehler M. Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer. Urol Oncol. 2013;31(4):455‒460. https://doi.org/10.1016/j.urolonc.2011.02.023

The authors declare that there are no conflicts of interest present.