Do you recommend prostate RT for patients with metastatic (M1) disease?

My short answer to this provocative question is “no, I don’t offer men with M1 disease local radiation unless there’s a palliative need.” Treating the primary in the asymptomatic M1 scenario, whether with RT or with surgery, is a major commitment of time, resources, and risk to the patient. The leve...

I’m excited and honored to see a discussion of this manuscript making it all the way to theMednet!

As Dr. @Dr. First Last points out, although the NCDB is an outstanding prospectively-maintained resource, it cannot replace prospective clinical trial data. This is not to say that the trends and outco...

The JCO paper is interesting but hypothesis generating and so we need to await the results of STAMPEDE before offering RT to men with M1 PC off study with the exception of cases where it is being offered for local control to reduce the risk of obstructive sx's later in a patient with large volume lo...

I am a clinician focused on prostate cancer since 1983 -- the so-called "dark ages". I may be the oldest HemOnc MD that continues in practice after all these years. Been there and done that for many aspects of this disease. What is missing in the discussion is a much more intense focus on the stagin...

The original question referenced STAMPEDE. The results have now been published and showed an OS benefit in a subgroup analysis for patients with "low" metastatic burden (the full trial showed a FFS benefit, but not OS). I offer prostate RT to patients with oligometastatic disease, with this analysis...

I have heard some arguments for definitive local treatment (prostatectomy or RT) for patients with oligomets, but I do not agree with this approach since there is no high-quality evidence to justify this approach. I only irradiate bulky primary prostate tumor with obstruction (failure in ADT) or for...

An intriguing consensus paper recently published showing a majority recommending primary site therapy for synchronous oligometastatic prostate cancer (https://www.ncbi.nlm.nih.gov/pubmed/28655541). Based on the above comments and this paper, I am currently leaning towards recommending radiation to t...

If the Radiation establishment believes in the Abscopal Effect, then now is the time to conduct studies of Radiation as an ablative procedure to be joined with immune therapy to increase the effectiveness of the Abscopal effect. M1 is a good indication and will save money and human suffering for the...