Stereotactic ablative body radiotherapy (SABR) for oligometastatic prostate cancer (omPC) has proven a topic of emerging interest in the paradigm shift from palliative androgen deprivation therapy (ADT) to metastasis-directed therapy.
In this study, we aim to evaluate and report on biochemical and clinical outcomes for omPC patients treated with SABR.
This was a multi-centre, retrospective case series of patients undergoing SABR for omPC from 2015 to 2019 inclusive, staged with PSMA-PET/CT. Concurrent ADT was permitted. Patients with synchronous metastatic disease receiving radiotherapy to primary within 12 months of SABR were excluded. The primary endpoint was biochemical failure-free survival (BCFFS). Secondary endpoints included: PSA response at 6 months, clinical failure-free survival (CFFS), defined by a 2nd course of SABR, commencing ADT, palliative radiotherapy, systemic therapy or changing current line of therapy; ADT-free survival (FS) was calculated in the SABR only cohort.
213 patients were included for analysis. 41.3 % of SABR was delivered to bone and 49.3 % to nodal metastases, with 28 patients (13.1 %) having SABR together with ADT. Median follow-up was 57.6 months (IQR 45.8-72.6). BCFFS at 12, 24 and 36 months was: 45.6 % (95 %CI: 38.7-52.2 %), 26.2 % (95 %CI: 20.4-32.4 %) and 18.8 % (95 %CI: 13.7-24.5 %), respectively. CFFS at 12, 24 and 36 months was: 71.4 % (95 %CI: 64.7-77.0 %), 50.4 % (95 %CI: 43.4-57.1 %) and 39.2 % (95 %CI: 32.4-45.8 %), respectively.Median ADT-FS was 41.98 months (95 %CI: 32.76-52.90), with 5-year ADT-FS reported at 37.5 % (95 %CI:29.8-45.1 %).
This is the largest cohort of PSMA PET staged patients undergoing SABR for omPC, effective in delaying treatment escalation and ADT exposure beyond 3 years.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2025 Oct 23 [Epub ahead of print]
Isabelle Schupak, Michael Chao, Mario Guerrieri, Huong Ho, Cristian Udovicich, Wee Loon Ong, Michelle Starmans, Mark Tacey, Farshad Foroudi, Daryl Lim Joon, Michael Ng
GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia; Oliva Newton-John Cancer Wellness & Research Centre (Austin Health), 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: ., GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia; Oliva Newton-John Cancer Wellness & Research Centre (Austin Health), 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: ., GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia. Electronic address: ., GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia. Electronic address: ., GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia. Electronic address: ., Monash University Wellington Road, Clayton, Victoria 3800, Australia. Electronic address: ., GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia. Electronic address: ., Oliva Newton-John Cancer Wellness & Research Centre (Austin Health), 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: ., Oliva Newton-John Cancer Wellness & Research Centre (Austin Health), 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: ., Oliva Newton-John Cancer Wellness & Research Centre (Austin Health), 145 Studley Road, Heidelberg, Victoria 3084, Australia. Electronic address: ., GenesisCare, St Vincent's Hospital, Basement Level Building, C/41 Victoria Parade, Fitzroy, Victoria 3065, Australia; GenesisCare, Epping Medical Centre, 320 Cooper Street, Epping, Victoria 3076, Australia. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41138859