Risk stratification has been conducted by various research groups and guidelines. Cases with a high risk of recurrence are defined as “high-risk PC”; however, because of the heterogeneity in prognosis among these cases, they have been further subdivided into “very high-risk PC”. Oligometastasis is considered as a metastatic carcinoma that lies between locally advanced carcinoma and widely metastatic carcinoma, and it should be treated separately from both in terms of prognosis and treatment.
The definitions of very high-risk PC reported so far are shown in Table 1.
Source (Year) | Definition | Reference |
---|---|---|
Spahn (2010) | 2 high-risk features (PSA > 20 ng/mL, GS 8–10, and cT3–4) | [16] |
Walz (2011) | [17] | |
Sundi (2014) | Primary Gleason pattern 5 or 4 cores containing pattern 4 | [19] |
Joniau (2015) | GS 8–10 in combination with 1 other high-risk factor (PSA > 20 ng/mL and cT3–4) | [18] |
NCCN guidelines (2019v2) | cT3b–4 or primary Gleason pattern 5 or >4 cores with Grade Group 4 or 5 | [20] |
EAU guidelines (2019) | cT3–4 or cN+, any PSA, any GS | [23] |
Study | No. of Patients | Eligibility Criteria | Treatment | Median Follow-Up | Outcome | Reference |
---|---|---|---|---|---|---|
Radical prostatectomy for patients presenting with locally advanced disease | ||||||
Moltzahn | 266 | cT3b–4, N0 or N1, M0 | RP + PLND ± adjuvant ADT and/or RT | 9.3 years | 10-year CSS 87.1–94.4% | [29] |
External beam radiotherapy for patients presenting with locally advanced disease | ||||||
RTOG 85-31 | 977 | cT3 or N1 or RP + PSM and/or SVI | RT vs. RT + ADT (lifelong) | 11 years | 10-year OS 39% vs. 49%, p = 0.002; 10-year CSS 78% vs. 84%, p = 0.005; 10-year MFS 61% vs. 76%, p < 0.0001 | [3,4] |
Intergroup randomized study | 1205 | cT3–4, N0/Nx, M0 or cT1–2 with either PSA > 40 ng/mL or PSA 20–40 ng/mL and GS 8–10 | ADT (lifelong) vs. ADT + RT | 8 years (range, 0–15.2) | 10-year OS 49% vs. 55% (HR 0.70, 95% CI 0.57–0.85, p < 0.001); CSS higher in combined treatment (HR 0.46, 95% CI 0.34–0.61, p < 0.001); 10-year PFS 46% vs. 74% (HR 0.31, 95% CI 0.25–0.39) | [5] |
STAMPEDE | 638/2962 | Two of the following are met; cT3–4, GS 8–10, PSA > 40 ng/mL | SOC vs. SOC + ZA vs. SOC + DOC vs. SOC + ZA + DOC | 3.6 years (IQR 2.5–5) | 5-year OS 55% vs. 57% vs. 63% vs. 60%; SOC + DOC (HR 0.78, 95% CI 0.66–0.93, p = 0.006) and SOC + DOC + ZA (HR 0.82, 95% CI 0.69–0.97, p = 0.022) compared to SOC only, respectively | [6] |
GETUG 12 | 413 | cT3–4 or GS 8–10 or PSA > 20 ng/mL or pN1 | ADT (3 years) + local treatment + CT (DOC + EMT) vs. ADT + local treatment | 8.8 years (IQR 8.1–9.7) | 8-year RFS 62% vs. 50% (adjusted HR 0.71, 95% CI 0.54–0.94, p = 0.017) | [7] |
Rusthoven | 796 | cT1–4, N1, M0 | RT vs. no local treatment | 5.2 years | 10-year OS 45% vs. 29% (HR 0.58, 95% CI 0.48–0.71, p < 0.001); 10-year CSS 67% vs. 53% (HR 0.61, 95% CI 0.47–0.80, p < 0.001) | [8] |
Lin | 3540 | cN1, M0 or Mx | ADT + RT vs. ADT alone | 5.2 years | 5-year OS 71.5% vs. 53.2% (HR 0.50, 95% CI 0.37–0.67, p < 0.001) | [9] |
Various modalities of radiotherapy | ||||||
Zelefsky | 296 | cT3, N0, M0 | 3D-CRT or IMRT+ ADT (3 months) | 8 years (range, 2–16) | 10-year RFS T3a/T3b: 44%/32%; 10-year CSS T3a/T3b: 88%/79% | [44] |
Mizowaki | 120 | cT3–4, N0, M0 | IMRT + ADT (6 months) | 97 months (range, 21–120) | 8-year RFS 53.2%; 8-year CSS 96.6%; 8-year OS 89.1% | [51] |
Goupy | 276 | cT3b, N0–1, M0 | IMRT + ADT (3 years) | 26 months (95% CI, 33–39) | 5-year RFS 75.2%; 5-year CSS 89.7%; 5-year OS 78.8% | [53] |
Yamazaki | 249 | cT3b–4, N0, M0 | HDR + EBRT vs. HDEBRT vs. Conv EBRT | 64 months (range, 13–153) | 5-year RFS 78.9% vs. 88.1% vs. 66.5% (p = 0.0003) | [73] |
Kishan | 1809 | Gleason score 9–10 | RP vs. EBRT vs. EBRT + LDR/HDR | RP, 4.2 years; EBRT 5.1 years; EBRT + LDR/HDR 6.3 years | 5-year MFS 76% vs. 76% vs. 92% (p < 0.001); 7.5-year OS 83% vs. 82% vs. 90% (p < 0.05) | [75] |
The recently reported definitions of oligometastatic PC are shown in Table 3.
Source | No. of Patients | Number of Metastases | Number of Metastases | Detection | Reference |
---|---|---|---|---|---|
Tabata | 35 | 5 | Bone only; each site < 50% size of vertebral body | Bone scan | [79] |
Ahmed | 17 | 5 | NS | 11C-choline PET–CT, MRI, biopsy, CT | [80] |
Berkovic | 24 | 3 | Bone or LN | Bone scan, 18F-FDG PET–CT, 11C-choline PET–CT | [81] |
Schick | 50 | 4 | NS | Bone scan, 18F-choline PET–CT, 11C-acetate PET–CT | [82] |
Decaestecker | 50 | 3 | Bone or LN | 18F-FDG PET–CT, 18F-choline PET–CT | [83] |
Ost | 119 | 3 | Any | 18F-FDG PET–CT, 18F-choline PET–CT | [84] |
This entry is adapted from the peer-reviewed paper 10.3390/cancers13174470