What is the timeframe for oligometastatic (having a limited number of metastases) prostate cancer to progress to castration-resistant (hormone-refractory) prostate cancer?

From the Guidelines

Oligometastatic prostate cancer typically progresses to castration-resistant prostate cancer within 14 to 30 months.

Timeframe for Progression

• The timeframe for oligometastatic prostate cancer to progress to castration-resistant prostate cancer is 14 to 30 months 1.
• This progression is characterized by the cancer becoming resistant to traditional androgen deprivation therapy (ADT) despite castrate levels of serum testosterone (<50 ng/dL) 1.

Factors Affecting Progression

• The frequency of imaging tests to monitor for signs of distant metastases is affected by individual risk, age, overall patient health, PSA velocity, and Gleason grade 1.
• Patients with a shorter PSA doubling time (≤10 months) are more likely to progress to castration-resistant prostate cancer 1.

Management of Castration-Resistant Prostate Cancer

• ADT with an LHRH agonist or antagonist should be continued to maintain castrate serum levels of testosterone (<50 ng/dL) 1.
• Additional systemic therapies, such as secondary hormone therapies, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies, may be applied sequentially depending on patient and disease characteristics 1.

From the Research

Timeframe for Oligometastatic Prostate Cancer Progression

The timeframe for oligometastatic prostate cancer to progress to castration-resistant prostate cancer is not explicitly stated in the provided studies. However, some studies provide insights into the progression of oligometastatic prostate cancer:

• A study published in 2021 2 mentions that metachronous oligometastatic prostate cancer is heterogeneous with slow progression compared to men with high-volume metastasis.
• A study published in 2023 3 reports a median time to metastatic castration-resistant prostate cancer of 50 months in oligometastatic hormone-sensitive prostate cancer patients treated with metastasis-directed therapy.
• Another study published in 2023 4 found that patients with a prostate-specific antigen doubling time of ≥6 months showed a higher response rate to site-directed therapy and longer progression-free survival.

Factors Influencing Progression

Several factors may influence the progression of oligometastatic prostate cancer, including:

• The number of metastases: A study published in 2021 5 suggests that the frequency of driver mutations increases with the number of metastases.
• The presence of certain genetic mutations: The same study 5 found that mutations in TP53 were associated with shorter radiographic progression-free survival and time to castrate-resistant prostate cancer.
• The use of androgen deprivation therapy and other treatments: A study published in 2023 3 reports that androgen deprivation therapy was combined with metastasis-directed therapy in 84% of patients, and that 19% received combination therapy with apalutamide or enzalutamide.

Treatment Outcomes

The provided studies report various treatment outcomes for oligometastatic prostate cancer, including:

• A 36-month survival rate of 90% and a 36-month rate of patients still on treatment with androgen receptor targeted agents of 50% 6.
• A median progression-free survival of 8.3 months and a median time to next treatment of 9.9 months 4.
• A median time to metastatic castration-resistant prostate cancer of 50 months and an overall mortality rate of 15% after 24 months 3.