How would you treat a patient with synchronous node positive prostate cancer (T3bN1M0) and oligometastatic rectosigmoid cancer (T4aN1M1) with a solitary liver metastasis?

I reached out to my colleague, Dr. @Dr. First Last, a radiation oncologist and co-director of the Prostate Cancer Center at Dana Farber, who has expertise in both genitourinary and gastrointestinal cancers for his thoughts on this question. Here is his answer:

Recognizing that the rectal cancer is likely to drive his overall outcome and anticipating that he wants to be maximally aggressive for local control for both processes, I would do the following:

• Get him on ADT and FOLFINOX (a la PRODIGE 23)
• Place fiducials in the prostate (though if you have a center that can set up to soft tissue on CBCT, may not be as crucial)
• Treat the
  • prostate to 70 Gy in 28 fractions
  • at risk nodal volumes up to the bifurcation of the aorta to 50.4 Gy in 28 fra...