https://doi.org/10.4081/aiua.2026.15530
Stereotactic radiotherapy in oligometastatic prostate cancer: a single-center experience
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Published: 29 May 2026
Introduction: Oligometastatic prostate cancer represents an intermediate disease state potentially amenable to metastasis-directed therapies such as stereotactic body radiotherapy (SBRT), aiming to delay disease progression and postpone systemic treatment. Aim: The aim of this study was to evaluate the real-world outcomes of SBRT in patients with hormone-sensitive oligometastatic prostate cancer.
Methods: This single-center retrospective study included patients with hormone-sensitive oligometastatic prostate cancer staged with PSMA PET and treated with SBRT at a tertiary center between January 2022 and March 2024. The primary endpoint was hormone therapy-free survival (HTFS). Secondary endpoints included event-free survival (EFS), local control, overall survival (OS), and toxicity.
Results: A total of 34 patients were included, predominantly with low-volume disease (79.4% with a single metastasis). SBRT achieved significant biochemical responses (PSA50 in 69.7%; median PSA nadir 0.19 ng/mL). HTFS rates were 85.2% and 74.6% at 12 and 24 months, respectively, with the median not reached. Median EFS was 16.2 months. Local control was 84.2%, and 24-month OS was 87.8%. Toxicity was minimal, with no grade ≥ 3 adverse events. A PSA nadir ≤ 0.20 ng/mL and ISUP ≤ 2 were associated with improved outcomes.
Conclusions: SBRT may delay systemic therapy without compromising disease control in oligometastatic prostate cancer. Its integration into personalized treatment strategies, guided by biological and biochemical factors, represents a promising therapeutic approach.
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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2022. CA Cancer J Clin. 2024; 74:33-52.
2. Rawla P. Epidemiology of prostate cancer. World J Oncol. 2019;10:63-89.
3. Kirby M, Hirst C, Crawford ED. Castration-resistant prostate cancer. Int J Clin Pract. 2011; 65:1180-1192.
4. Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer (proPSMA). Lancet. 2020; 395:1208-1216.
5. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995; 13:8-10.
6. Ost P, Bossi A, Decaestecker K, et al. Metastasis-directed therapy in oligometastatic prostate cancer. Eur Urol.2015; 67:852-863.
7. Guckenberger M, Lievens Y, Bouma AB, et al. Characterisation and classification of oligometastatic disease. Lancet Oncol. 2020; 21:e18-e28.
8. Gillessen S, Attard G, Beer TM, et al. Management of patients with advanced prostate cancer: APCCC 2019. Eur Urol.2020;77:508-547.
9. Tree AC, Khoo VS, Eeles RA, et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol. 2013; 14:e28-e37.
10. Ost P, Reynders D, Decaestecker K, et al. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): a randomized phase II trial. J Clin Oncol. 2018; 36:446-453.
11. Phillips R, Shi WY, Deek M, et al. Outcomes of observation vs stereotactic ablative radiation for oligometastatic prostate cancer (ORIOLE). JAMA Oncol. 2020; 6(5):650-659.
12. Franzese C, Comito T, Clerici E, et al. Stereotactic body radiotherapy in oligometastatic prostate cancer. Clin Oncol (R Coll Radiol). 2021; 33:e284-e292.
13. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2024.
14. Tran PT, et al. Stereotactic ablative radiotherapy for oligometastatic prostate cancer: patterns of failure. Int J Radiat Oncol Biol Phys. 2018; 102:1304-1310.
15. Decaestecker K, De Meerleer G, et al. Repeated stereotactic body radiotherapy for oligometastatic recurrence. Eur Urol. 2014; 66:45-53.
16. Palma DA, Olson R, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers (SABRCOMET). Lancet. 2019; 393:2051-2058.
17. Marvaso G, Corrao G, Zaffaroni M, et al. ADT with SBRT versus SBRT alone for hormone-sensitive oligorecurrent prostate cancer (RADIOSA): a randomised, open-label, phase 2 clinical trial. Lancet Oncol. 2025; 26:300-311.
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CRediT authorship contribution
AMF: Study conception and design; acquisition of clinical data; data curation; data analysis and interpretation; drafting of the original manuscript; critical revision for important intellectual content; JMC: Data curation; data analysis and interpretation; preparation of tables and figures; drafting of sections of the manuscript; ETS: Data curation; data analysis and interpretation; critical revision of the manuscript; PN: Study conception and design; supervision; contribution to manuscript writing and editing; critical revision for important intellectual content; AF: Study conception and design; supervision; critical revision for important intellectual content; final approval of the manuscript.
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Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and institutional restrictions but are available from the corresponding author on reasonable request.
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