That hit the spot.

Evidence is building across a wide array of cancers for the aggressive treatment of oligometastatic sites, but today let’s take a look at prostate cancer. Though androgen deprivation (ADT) is generally the treatment of choice, it’s reasonable in men with no symptoms to hold ADT until symptomatic. Why? Because ADT is quite the Buzz Killington. A phase 2 trial in JCO randomized men with 1-3 asymptomatic metastatic foci after definitive prostate treatment to observation versus surgery or SBRT, aka metastasis-directed therapy (MDT), to see which arm would live longer without having to start ADT. MDT appeared to increase ADT-free survival from 13 to 21 months with 81% of observed patients starting ADT versus 61% of those who got MDT. While we love the idea of treating oligomets, this data is far from a slam dunk. First of all, the majority of patients in both arms started ADT upon developing more than 3 mets--as opposed to upon becoming symptomatic--which seems a little arbitrary. More importantly, there was no difference in patient reported quality of life, arguably the better endpoint based on their study rationale. Now that we’ve got you, let’s both revisit the birth of the D’oyly Carte Opera Company...