Do you offer treatment of prostate/oligomets upfront with systemic therapy for oligometastatic de novo prostate cancer?

There's no right or wrong answer here, and I've done both options (treat everything up front and treat sequentially) based on disease sites and volume, and patient symptoms and priorities. I can share how I think through the decision-making:

1. Do they qualify for prostate RT based on STAMPEDE and life...

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...

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...