For oligometastatic de novo prostate cancer. Do you offer treatment of prostate/oligomets upfront with systemic therapy? If treating the prostate/pelvic nodes/pelvic bony met, what dose do you take the bony metastases to if in the same course as prostate.

The additive value of MDT in addition to prostate-directed therapy for patients with de novo oligometastatic disease is currently unknown. As it is possible that the biology of such de novo presentations may differ meaningfully from metachronous presentations, extrapolation from the metachronous set...

We do not know if metastasis-directed RT is beneficial for de novo oligometastatic prostate cancer, where the standard is to give doublet (or triplet) systemic therapy. For these patients, I recommend one of the two RCTs we currently have open to investigate this question (TERPS: NCT05223803; TRITON...