Local therapy in patients with metastatic prostate cancer: a new standard of care?
Historically, the standard of care for patients with metastatic prostate cancer was androgen deprivation therapy (ADT). With the publication of CHAARTED, LATITUDE, and STAMPEDE, there are randomized data (1-3), and meta-analysis of randomized data (4), to support the addition of docetaxel and abiraterone in these patients. While local treatment such as radical prostatectomy and prostate irradiation are standard for patients with localized disease, the role of local therapy in patients with distant metastases has been controversial until very recently (5). Although there is data to suggest that patients with oligometastatic prostate cancer may derive oncologic benefit from prostate directed treatment, many of the published studies to date are retrospective (6). As such, selection bias (with patients with lower overall disease burden being treated more aggressively at the local site and ultimately having a greater survival) may account for many of the observed benefits in these studies.