PROSTATE cancer (PCa) remains a major global health issue, ranking as the second most common malignancy among men. Although less prevalent in China than in the West, its incidence has surged in recent years, with oligometastatic prostate cancer (OMPC), a state with limited metastasis, gaining increasing attention. While androgen deprivation therapy (ADT) has long been the mainstay of treatment, resistance often develops, underscoring the need for new therapeutic approaches.
A Chinese research team has recently completed the world’s first Phase I/II clinical trial exploring the use of neoadjuvant radiotherapy combined with hormone therapy prior to surgery for OMPC. This “sandwich” approach, consisting of radiotherapy, radical prostatectomy, and novel endocrine treatments, aims to improve long-term outcomes in a group historically treated with systemic therapies alone.
The trial applied intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) to both primary and metastatic tumour sites, followed by robotic-assisted radical prostatectomy (RARP). All patients tolerated the treatment well, with no severe side effects and full recovery of urinary control within 18 months. Impressively, the study reported a 91.7% recurrence-free survival rate after three years of follow-up.
These early results support the theory that combining systemic and localised treatment in OMPC can improve tumour control and surgical outcomes. This strategy appears particularly effective in reducing tumour activity before surgery, increasing downstaging rates, and enhancing operability.
Building on this success, the team is launching a larger, prospective multicentre randomised controlled trial named NEAR-TOP. This study will assess whether this tri-modal “sandwich” therapy delivers superior outcomes compared to standard hormone therapy alone. With rigorous patient follow-up and collaboration between leading research centres, the trial promises to offer high-quality evidence on a promising treatment model.
In an era of personalised cancer care, this integrative approach could redefine OMPC management, potentially shifting the treatment paradigm from palliative care toward curative intent.
Reference
Fan Z et al. NEoAdjuvant radiohormonal therapy versus standard of care for oligometastatic prostate cancer (NEAR-TOP): study protocol of a multicenter, open-label, randomised controlled trial. BMC Cancer. 2025;25(1):768.
