A recent study suggests a new approach to treating oligoprogressive metastatic castration-resistant prostate cancer (mCRPC) that could significantly delay the need for more aggressive systemic treatment. The standard approach for patients with mCRPC that shows signs of progression is next-line systemic treatment (NEST). However, the MEDCARE trial investigated the effectiveness of a progression-directed therapy (PDT) approach for patients with a limited number of new or progressing lesions.

PDT involves targeting radiotherapy at these specific lesions while the patient continues their ongoing systemic therapy. The study, a prospective, single-arm, non-randomized phase 2 trial, found that PDT resulted in a median NEST-free survival (NEST-FS) of 17 months. This means that, on average, patients who received PDT were able to delay the need for NEST for 17 months. Importantly, the study also found that PDT was associated with very low toxicity, with no patients experiencing grade ≥3 toxicity.

This research suggests that PDT may be a safe and effective way to delay the need for NEST in patients with oligoprogressive mCRPC. This is particularly important because NEST can often have significant side effects. Further research is needed to confirm these findings and to determine which patients are most likely to benefit from PDT.
The full results of the MEDCARE trial were published in the journal European Urology Oncology.

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