There is a lot of discussion about oligometastatic disease lately. Particularly as these new methodologies come to the forefront, some people are even talking about the possibility of curing oligometastatic disease. I was just kind of curious: do you guys think that’s a possibility? Is this something we should even be talking about with our patients, or do we need to really stick to talking about cure when the disease is still confined?

Well, I can chime in on that one. Yes, Dr Sartor, that’s what patients want to hear, and frankly, that’s what we need to be striving for. I don’t think we can make any promises on any of these things, but if we’re not even trying in a newly diagnosed oligometastatic patient to try to get to a complete response, we’re never going to get to cure. I think that it is appropriate to say that’s what we’d like to achieve, but we don’t know yet if we can do that yet. Anecdotally we’ve seen some remarkable cases that would suggest that we can, but anecdotes are just the first step. What we will need are prospective studies that suggest, in a phase 2 setting, that yes we can achieve that. Then we’ll need to see it in a randomized study. But to me, this must be part of our goal. It’s the most important thing for these patients. Frankly, particularly for the younger patients who have a long-expected survival otherwise, I think we’re doing a disservice if we’re not at least entertaining that as a possibility.

I think that we’re in a philosophical shift, where prostate cancer, especially metastatic prostate cancer, was viewed as an eventually lethal disease in older men who would likely “die with it rather than of it.” But we do know that there is a shift going on, not only because younger men are getting prostate cancer and that men are not dying of other problems like cardiovascular disease, but also because there’s a tremendous amount of morbidity and poor outcomes related to living with prostate cancer that we haven’t been addressing aggressively.

I would agree with that, but I think an important distinction is whether the patient has hormone-sensitive disease or is castrate resistant. We all know that patients can be treated for years and they’re hormone sensitive – and different modalities will work – and we can really get a very nice, long, disease-free interval. Once they shift to being castrate resistant, however, it becomes much more difficult to manage. I think we really need to advance the field of modalities for that phase of the disease if we want to speak about cure. But certainly for patients who are hormone sensitive and have oligometastatic disease, a very aggressive approach with the hope of cure is, I think, reasonable.