How to cite: Goldberg H. “How Aggressive Should We Be in Oligometastatic Disease?” Grand Rounds in Urology. August 2026. Accessed Oct 2026. https://grandroundsinurology.com/how-aggressive-should-we-be-in-oligometastatic-disease/
Summary
In this presentation from the UroCancer Interdisciplinary Forum (UCIF) 2026, Hanan Goldberg, MD, MSc, SUNY Upstate Medical University, Syracuse, New York, reviews the current evidence supporting metastasis-directed therapy (MDT) for oligometastatic prostate cancer while emphasizing that patient selection, systemic therapy, and disease biology remain central to treatment decisions.
Dr. Goldberg first reviews studies evaluating MDT alone compared with observation, including STOMP and ORIOLE. These trials demonstrated improvements in androgen deprivation therapy-free survival and progression-free survival among carefully selected patients with metachronous oligorecurrent hormone-sensitive prostate cancer. Dr. Goldberg emphasizes that most patients ultimately experienced disease progression, supporting the conclusion that MDT alone should not replace systemic therapy.
He discusses trials evaluating MDT combined with systemic therapy, including EXTEND, RADIOSA, PEACE V-STORM, and the WOLVERINE individual patient data meta-analysis. Collectively, these studies suggest that adding MDT to systemic therapy improves progression-free, radiographic progression-free, and castration resistance-free survival compared with systemic therapy alone, although an overall survival benefit has not yet been established.
Dr. Goldberg explains that while prostate-specific membrane antigen positron emission tomography substantially improves lesion detection, it also introduces important sources of bias, including stage migration, lead-time bias, selection bias, hidden-lesion bias, and response-assessment confounding. These factors complicate the interpretation of clinical outcomes and comparisons with historical studies based on conventional imaging.
Dr. Goldberg shares a practical clinical framework for incorporating MDT into routine practice. He recommends considering MDT alone only in highly selected patients whose primary goal is delaying androgen deprivation therapy, whereas MDT combined with systemic therapy currently has the strongest evidence for improving disease control.
ABOUT THE AUTHOR
Hanan Goldberg, MD, MSc, is an Associate Professor of Urology at SUNY Upstate Medical University in Syracuse, New York, specializing in urologic oncology. His clinical expertise encompasses prostate, kidney, bladder, testicular, penile, urethral, and adrenal cancers, as well as benign prostatic hyperplasia. His research interests include clinical and translational research in urologic malignancies, with a particular focus on prostate cancer prevention and treatment.
Dr. Goldberg earned his medical degree from Hebrew University Hadassah Medical School in Jerusalem, Israel, and completed his urology residency at Rabin Medical Center in Israel. He subsequently completed a three-year fellowship in urologic oncology at Princess Margaret Cancer Centre and the University of Toronto, where his training included robotic, minimally invasive, and open surgical approaches. He also earned a Master of Science in clinical epidemiology from the University of Toronto. Dr. Goldberg is a member of the American Urological Association and the Society of Urologic Oncology.
