POSTED: October 22, 2015

Piet Ost + Paul Okunieff on Oligometastatic Disease

Dr. Piet Ost

Dr. Piet Ost

In the January 2015 V 16 # 7 issue of Prostate Forum, we feature conversations with Dr. Paul Okunieff of the University of Florida and Dr. Piet Ost of Ghent University about oligometastatic prostate cancer.

Here’s Dr. Myers’s introduction to the issue.

Download the issue to read the entire interview.

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from Prostate Forum January 2015 Vol 16 # 7

As long-term readers of Prostate Forum know, I have a long-term interest in the issue of oligometastatic prostate cancer and its optimum management.

Dr. Paul Okunieff

Dr. Paul Okunieff

For full disclosure, I had oligometastatic prostate cancer when I was diagnosed in February 1999.The scans indicated involvement of the pelvic nodes at the time of diagnosis. Additionally, both seminal vesicles were involved and there was extracapsular extension. Projected survival was less than 5% at ten years.

In 1999, oligometastatic disease was a concept proposed for other diseases, but not for prostate cancer.

At that time, Dr. Michael Dattoli was the only one who would consider treating the sites of metastatic disease. During our discussions, we analyzed in detail the likelihood of damage to normal tissues. This was a time when 3-D con- formal radiation was the norm and serious damage to the adjacent bowel and rectum was a given.

My wife and I went out to a nice Japanese restaurant and reviewed the options. As a medical oncologist, I was well aware of the limited effectiveness of the drugs and hormonal therapy.

I elected to accept the damage for a chance at improving my odds. As expected, I did have severe damage to my colon and had to take a year off from work because of severe bleeding.

Fortunately, I was able to recover and now 15+ years later my PSA remains undetectable. I have had a normal testosterone since Winter 2001.

While I am glad to be disease-free, over the years I have seen many men not achieve long- term disease control.

Given my own experiences, I have become very interested in how to best define who will benefit from treatment for oligometastatic disease. I think we also need to best determine the safest way to treat oligometastatic disease. Options include surgery and a growing list of radiation therapies.

In our January 2015 issue, we’re featuring conversations with two important contributors to this area of oligometastatic prostate cancer.

The first conversation is with Dr. Paul Okunief from the University of Florida, who authored the first paper to propose that a portion of men with prostate cancer have oligometastatic disease and that those patients have five or fewer bone lesions. This remains a reasonable guideline.

The second interview is with Dr. Piet Ost of Ghent Universiy, who is running the first randomized controlled trial on oligometastatic disease. Dr. Ost is also one of the most productive researchers in the field. I have really enjoyed reading his papers and encourage you to read them as well.

Read carefully what each of these investigators says about reasonable guidelines for selecting men for oligometastatic treatment.

In two recent videos on my blog on December 5, 2014 and November 13, 2014, I have recounted the immunosuppression I see in men when these guidelines are not adhered to. Dr. Ost gives a detailed discussion of his use of radiation and, based on what I have seen at my clinic, such a cautious approach is not likely to experience significant immunosuppression. However, it is only within the context of a well-run randomized trial that we can accurately assess the true incidence of side effects.

Download the issue to read the interviews in their entirety.

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