Systematic review and meta-analysis of addition of metastasis-directed therapy to standard of care for oligometastatic prostate cancer

Oligometastic disease (up to five metastases) represents the proximal end of a metastatic spectrum. Metastasis-directed therapy (MDT) is increasingly used to treat oligometastatic disease despite the absence of level 1 evidence. Systematic review and individual patient data meta-analysis evaluated the effectiveness of MDT for oligometastatic prostate cancer. In the literature up to May 4,2025, the authors identified six phase 2 studies comparing MDT plus standard therapy (SOC) versus SOC alone among 472 patients. Comprimary endpoints were progression-free survival (PFS) and overall survival (OS). At a median follow-up of 40.7 months (IQR 25.6-53.7), addition of MDT was associated with improved PFS (trial-level HR 0.44; p<0.0001; patient-level HR 0.45; p<0.001), radiographic PFS (trial-level HR 0.60; p=0.0039; patient-level HR 0.59; p<0.001), and castration resistance-free survival (trial-level HR 0.58; p=0.019; patient-level HR 0.58; p=0.017), but not overall survival (trial-level HR 0.63; p=0.051; patient-level HR 0.64; p=0.057). The authors conclude that this analysis showed a benefit with MDT for oligometastatic prostate cancer in PFS, radiographic PFS, and castration resistance-free survival.