Editor’s Note: Oligometastatic prostate cancer occupies a unique clinical space—it is neither confined entirely to the prostate nor widely metastatic throughout the body. This intermediate state presents distinct therapeutic challenges and opportunities.
At the recent National Cancer Center Urologic Oncology Symposium & Medical Frontiers Forum (NCCU 2025), Oncology Frontier – UroStream invited Prof. Peter Hammerer from Academic Hospital Braunschweig, Brunswick, Germany, to deliver an insightful lecture on treatment strategies for oligometastatic prostate cancer.
01
Oncology Frontier- UroStream: The definition of oligometastatic prostate cancer is not universally agreed upon and exhibits significant heterogeneity. In clinical practice, how do you screen patients who may benefit from surgery?
Dr. Peter Hammerer: Well, thank you very much for this really important question. You are absolutely correct, the definition of oligometastatic disease varies. So usually we are talking about oligometastatic disease when we detect between one to three metastatic lesion. However, this also depends on the imaging modality. So we know with CT scan and bone scan, the detection rate is lower compared to new technologies like, for example, PSMA PET. So with PSMA PET scanning, we detect much more metastatic lesions.
And the question is always, you know, what to do? Is there a role for local therapy? And there was really a shift within the last years that we realized that for men with low-volume metastatic disease, one to three metastatic lesions, there is indeed a benefit when you offer in addition local therapy. So I think it really makes sense identifying these lesions and offer these men a specific treatment. And I believe that local therapy should be part of the whole treatment options we give to the patient.
02
Oncology Frontier- UroStream: For local treatment of the primary lesion, in addition to radical prostatectomy, radiotherapy is also an important option. For different patient populations, what are the advantages and disadvantages of these two methods in terms of tumor control, quality of life, and complications?
Dr. Peter Hammerer: So, we know from large phase three clinical trials that there is a proven benefit when we offer radiation therapy in addition to long-term ADT to men with locally advanced disease or metastatic disease. So radiation therapy works for these men. However, some of these men have obstructive symptoms, you know, residual urine, having problems going to the toilet for urinating. So these are men where I believe that radical prostatectomy is more beneficial compared to radiation therapy.
But patient selection, I believe is very important. So I would only offer radical prostatectomy to those men where I have a very high chance of having a negative surgical margin. So when we always do MRI scan and transrectal ultrasound before we discuss what we should offer. So if I see a patient with wide involvement of the tumor in the sphincter muscle or in the rectal wall or in the bladder neck, I don’t think that he is a good candidate for surgery. He needs systemic therapy and then we offer radiation therapy. But for those men with really localized disease in the prostate, we do imaging, we see two metastatic lesion, we offer radical prostatectomy with good outcome, with good results, and then we discuss treatment of the metastasis and treatment systemic treatment.
03
Oncology Frontier- UroStream: The emergence of new technologies such as PSMA targeted therapy has brought new possibilities. How do you view its role in oligometastatic diseases?
Dr. Peter Hammerer: Again, this is a very good question and you know, I just came back from the ESMO meeting in Berlin, which was one months ago and there were some interesting data showing that for example, when offering, you know, two cycles of radioligand therapy with PSMA Lutetium, there is an improvement compared to standard therapy. So I really believe that, you know, offering maybe two cycles of radioligand therapy are really beneficial.
You always have to balance side effects of the treatment with the benefit for the patient. And we know, especially in low volume disease, side effects of radioligand therapy can be high, especially if you offer, you know, up to six cycles. So, I think this is not the way forward, but maybe offering one or two cycles is beneficial, but we need good clinical data, good clinical trials really to prove that there is a benefit for the patient because this is what is important.
Peter Hammerer
