Is there a role of definitive radiation or prostatectomy, in a patient who has M0 castrate resistant prostate cancer and whose PSA is undetectable on ADT and enzulatamide?

The question posed comes from a rather unusual clinical situation. In most cases, M0 crpc would have evolved from a diagnosis of prostate cancer and the application of curative intent local therapy surgery/radiotherapy, with psa progression in the absence of metastatic disease managed with ADT now with biochemical progression. The presumption is that the patient was managed without local therapy with ADT, now with enzalutamide added and now the question about local therapy arises. This is clearl...

There is a role for radiation to the primary site in men with low volume (oligometastatic) HSPC, based on recent data from STAMPEDE in 2019, which demonstrated a survival benefit in this subset of men, but no benefits to men with higher volume disease patterns of spread. This suggests that the primary may contribute to further clonal evolution and metastasis and death when the extraprostatic disease volume is low, but that in patients with large volumes of disease outside of the prostate, furthe...