Top Line: Metastasis directed therapy can benefit many patients with oligometastatic prostate cancer. It can even be used to delay ADT, but is there a better way to select the patients who benefit most?
The Study: In this study, a cohort of 586 patients with oligometastatic prostate cancer was used to develop a nomogram to predict ADT-free survival after MDT. Another 131 patients were used as a validation cohort. All patients had metachronous oligorecurrent disease in either the pelvic nodes (52%) or at distant sites (48%). Over half (62%) had a single site of disease. They were treated with MDT alone with no systemic therapy or ADT. At 1 year, the rate of ADT-free survival was 84.3%, at 2 years it was 68.3%, at 3 years it was 55.9%, and at 5 years it was 37.3%. For node-only disease, the rate of ADT free survival was 89.6% at 1 year and 64.5% at 3 years. Factors in the final validated prediction model included: number of lesions, pre-treatment PSA, pre-treatment PSA doubling time, and nodal versus distant metastasis status. The nomogram performed modestly in predicting individual outcomes, but it allowed for clinically meaningful risk group stratification. Those with a low score (<25th percentile) had a 2 year ADT free survival of 84.1%. Those with an intermediate score (25th to 75th percentile) had a 2 year ADT free survival of 71.3%, and those with a high score (>75th percentile) had a 2 year ADT free survival of just 44.9%.
TBL: Use this web-based nomogram to help estimate ADT free survival after MDT alone for oligorecurrent prostate cancer. | Soeterik, Lancet Oncol 2026
The Study: In this study, a cohort of 586 patients with oligometastatic prostate cancer was used to develop a nomogram to predict ADT-free survival after MDT. Another 131 patients were used as a validation cohort. All patients had metachronous oligorecurrent disease in either the pelvic nodes (52%) or at distant sites (48%). Over half (62%) had a single site of disease. They were treated with MDT alone with no systemic therapy or ADT. At 1 year, the rate of ADT-free survival was 84.3%, at 2 years it was 68.3%, at 3 years it was 55.9%, and at 5 years it was 37.3%. For node-only disease, the rate of ADT free survival was 89.6% at 1 year and 64.5% at 3 years. Factors in the final validated prediction model included: number of lesions, pre-treatment PSA, pre-treatment PSA doubling time, and nodal versus distant metastasis status. The nomogram performed modestly in predicting individual outcomes, but it allowed for clinically meaningful risk group stratification. Those with a low score (<25th percentile) had a 2 year ADT free survival of 84.1%. Those with an intermediate score (25th to 75th percentile) had a 2 year ADT free survival of 71.3%, and those with a high score (>75th percentile) had a 2 year ADT free survival of just 44.9%.
TBL: Use this web-based nomogram to help estimate ADT free survival after MDT alone for oligorecurrent prostate cancer. | Soeterik, Lancet Oncol 2026