Top Line: Which men with metachronous oligometastatic prostate cancer get long-term mileage out of comprehensive SBRT in lieu of systemic therapy escalation?
The Study: A large UK single-center retrospective series describes outcomes for 234 men (308 lesions) treated with SBRT for ≤3 metachronous hormone-sensitive prostate cancer metastases between 2011–2023. Just under 60% received concurrent short-course ADT at clinician discretion. After a median follow-up of nearly 5 years, median radiographic progression-free survival clocked in at 22 months and ADT-free survival at 42 months. At 5 years, 23% were still radiographically recurrence-free and 42% remained off long-term ADT—numbers that hint at a bona fide long-term responder phenotype. So who are they? Faster PSA kinetics (read a doubling time ≤3 months) strongly predicted earlier progression (HR 1.52). And while concurrent ADT did indeed appear to delay radiographic progression (HR 0.52) and time to ADT (HR 0.40), it did not prolong eugonadal outcomes. Unsurprisingly, receipt of baseline PSMA PET/CT (aka ideal) staging identified patients with a notably longer ADT-free interval (52 vs 32 months). Finally, more than one metastasis and/or nodal involvement at initial diagnosis were associated with worse prostate cancer–specific survival.
TBL: SBRT can buy years of disease and ADT-free survival for a meaningful subset of men with metachronous oligomets—particularly those with slower PSA kinetics, limited lesion count, and PSMA-PET staging. | Yasar, Int J Radiat Oncol Biol Phys 2025
The Study: A large UK single-center retrospective series describes outcomes for 234 men (308 lesions) treated with SBRT for ≤3 metachronous hormone-sensitive prostate cancer metastases between 2011–2023. Just under 60% received concurrent short-course ADT at clinician discretion. After a median follow-up of nearly 5 years, median radiographic progression-free survival clocked in at 22 months and ADT-free survival at 42 months. At 5 years, 23% were still radiographically recurrence-free and 42% remained off long-term ADT—numbers that hint at a bona fide long-term responder phenotype. So who are they? Faster PSA kinetics (read a doubling time ≤3 months) strongly predicted earlier progression (HR 1.52). And while concurrent ADT did indeed appear to delay radiographic progression (HR 0.52) and time to ADT (HR 0.40), it did not prolong eugonadal outcomes. Unsurprisingly, receipt of baseline PSMA PET/CT (aka ideal) staging identified patients with a notably longer ADT-free interval (52 vs 32 months). Finally, more than one metastasis and/or nodal involvement at initial diagnosis were associated with worse prostate cancer–specific survival.
TBL: SBRT can buy years of disease and ADT-free survival for a meaningful subset of men with metachronous oligomets—particularly those with slower PSA kinetics, limited lesion count, and PSMA-PET staging. | Yasar, Int J Radiat Oncol Biol Phys 2025