mCRPC in focus
Transcript: Oligometastatic disease at ASCO GU 2025
Professor Silke Gillessen
Interview recorded February 2025. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
Yes. One of the really important topics that we have nowadays is oligometastatic disease, where we actually don't really know always well how we want to treat them. There was a very nice session about oligometastatic disease with an interesting panel of radio-oncologists, if I remember well, also oncologists, then someone from radiology. I think that was really very smart to have a radiologist in that panel. And in that sense, it was really a quite important session as well because it has so much changed with the advent of PSMA PET/CTs. So we see so many more patients with oligometastatic disease if we take the PSMA PET, because now a lot of patients with high-risk disease are staged with a PSMA PET. And even if in conventional imaging, they would be negative for metastasis, so M0, now we find in the PSMA PET single metastasis. And, so this is really something that we see more and more.
The same thing happens with biochemical relapse. Now, in a lot of countries, the imaging of choice for biochemical relapse is PSMA PET. And, of course, we see many more oligometastatic patients than with the conventional imaging. So in that sense, I think it's really a whole new group of patients. Personally, I think, you know, even if in the studies that we have, in a lot of these studies, the patients were defined by conventional imaging. Nowadays, and we saw that also in our consensus conference, most people would add on a PSMA PET to be sure that these patients are really oligometastatic. And we had a lot of discussion, there was a lot of discussion, I mean, is it three meds that are the upper limit, is it five?
I guess, you know, in the end, nobody really knows. It's not so clearly defined. In a lot of trials, five is taken as a cutoff. So I think that was quite an interesting discussion around this topic and how to treat these patients. And, of course, it's different if these patients are de novo oligometastatic or relapsed oligometastatic or even oligoprogressive, so on the treatment and only one or two of the lesions are growing or are new and all the others are stable. So we have a lot of these new kind of situations. And there was also a very interesting abstract, Abstract 22, presented by Dr. Niazi from Canada, who randomised 100 patients with mCRPC who had five, so they used five, five or less metastasis. And these patients were randomised to either ADT plus enzalutamide or ADT plus enzalutamide plus SBRT of the metastasis. And, I mean, it's not a large trial, but quite interesting. The hazard ratio for radiological progression-free survival was 0.5. So it's also that quite impressive. I think we have to learn, I mean, even better about, you know, because probably to be more granular, because probably, again, these patients are not all the same. But I think that was a really interesting story and an interesting abstract, and also very good session.
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