Do you offer prostate RT to men with 0-3 bone metastases on conventional imaging when PSMA PET shows a very high number of M1 lesions?

This would be a hard no from my standpoint.

I get the rationale here. STAMPEDE found a survival benefit for prostate-directed RT in men with "low volume" disease, which was defined based on the CHAARTED trial with conventional imaging. Therefore, men with low-volume disease on conventional imaging fi...

Great question, as we are seeing this clinical scenario more and more in practice. I don't think we have a clear answer on this, and I am curious to know how others would approach this case.

There are a few points I'd like to discuss.

Many of the CHAARTED low-volume patients are expected to have pol...

This is definitely a case-by-case decision based on many patient-related factors and the exact degree and location of disease burden (is it high volume because there are 6 lesions and not 5?, bulky pelvic nodes, etc), but often yes based on PEACE-1 showing the reduced risks of GU complications and t...

I believe the PSMA scan is more sensitive than conventional imaging, so I wouldn't treat with the intention that OS will be impacted. PEACE-1 is another trial that looked at this, presented at ASCO 2023.

Summary: Prostate-only RT doesn't appear to impact OS in 'low-volume' patients, though there is ...