Do you offer RT both to the prostate and synchronous oligometastases in de novo oligometastatic prostate cancer?

We do not yet have good evidence to tell us whether or when we should offer metastasis-directed therapy (MDT) for de novo oligometastatic prostate cancer. ORIOLE (like STOMP) was conducted in the recurrent setting. Those trials showed that MDT could delay progression and possibly allow a delay in th...

Offer a man a lifetime of ADT or upfront radiotherapy and intermittent ADT, and I think most patients would pursue the latter. The EXTEND phase 2 trial of metastasis directed therapy may offer a way to treat all sites of metastatic disease (maximum 5) combined with limited duration ADT. And limited ...

Good question and excellent discussion so far.

Just to add that we have just finished an RCT trial looking at this question and patients with de-novo oligometastatic disease were included. Patients had to have metastatic disease on conventional imaging (not just on PSMA PET).

Patients were randomiz...

The PEACE 1 trial on de novo metastatic, castration-sensitive prostate cancer is now published for radiotherapy and is noteworthy for several beneficial and clinically relevant results. It has not found a benefit in overall survival; however, it may be that longer follow-up is necessary.

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Yes, depending on the number of mets.

De novo low volume disease behaves similarly to metachronous high-volume at least from standard of care a few years ago, which as we know (thankfully) changes rapidly these days in prostate. This doesn't mean (to me) that we should withhold MDT in de novo low volume. I think it is very case-specific...