title: "Hit the primary": A paradigm shift in the treatment of metastatic prostate cancer?
abstract: Patients with metastatic prostate cancer (PC) represent a heterogeneous group with survival rates varying between 13 and 75 months. The current standard treatment in this setting is hormonal therapy, with or without docetaxel-based chemotherapy. In the era of individualized medicine, however, maximizing treatment options, especially in long-term surviving patients with limited disease burden, is of capital importance. Emerging data, mainly from retrospective surgical series, show survival benefits in men diagnosed with metastatic PC following definitive therapy for the prostate. Whether the irradiation of primary tumor in a metastatic disease might improve the therapeutic ratio in association with systemic treatments remains investigational. In this scenario, modern radiation therapy (RT) can play a significant role owing to its intrinsic capability to act as a more general immune response modifier, as well as to the potentially better toxicity profile compared to surgery. Preclinical data, clinical experience, and challenges in local treatment in de novo metastatic PC are reviewed and discussed.
authors.affiliation: Radiation Oncology, San Camillo and Forlanini Hospital - Rome, Italy. Electronic address: stefano.arcangeli@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Arcangeli
authors.affiliation: Radiation Oncology Department, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilli
authors.affiliation: Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) - Lausanne, Switzerland.
authors.forename: Berardino
authors.initials: B
authors.lastname: De Bari
authors.affiliation: Radiation Oncology Department, Sacro Cuore - Don Calabria Hospital - Negrar, (Verona), Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
mesh_terms: D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: Definitive treatments of the primary tumour; Local radiotherapy; Metastatic prostate cancer