Gray zone.

Where we once thought of cancer as metastatic or not, we are more and more commonly viewing oncologic processes as one big spectrum. This editorial points out that the recent coining of an “oligometastatic” category has once again lead many to stick the same label on a very disparate diseases, particularly in the realm of prostate cancer. Sure, we all know the cut-off for 5 bone mets. But now we have yet another layer of complexity with advanced novel targeted imaging techniques using choline or PSMA that reveal metastatic deposits at soaring rates of sensitivity. What’s particularly disconcerting is that men who have traditionally received definitive therapies to the prostate may forfeit prolonged disease control by skipping straight to systemic therapy alone if such imaging unmasks their indolent distant disease. TBL: The threshold should be high to withhold prostate-directed therapy due to oligomets discovered with novel imaging. | Connor, JAMA Oncol 2019