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Metastasis-Directed Therapy for Low-Volume mHSPC - Luis Salgado

September 19, 2025

Zachary Klaassen hosts Luis Salgado to discuss metastasis-directed therapy for low-volume hormone-sensitive prostate cancer. The conversation highlights the challenge of interpreting disease volume in the PSMA-PET era, where micrometastases and visceral lesions are detected more frequently than with conventional imaging. Dr. Salgado emphasizes the importance of STAMPEDE Arm H data showing survival benefits from primary prostate radiotherapy specifically in low-volume disease, but not high-volume cases. They discuss the evidence for SBRT to oligometastatic disease, noting that while promising, most data remains from early-phase trials requiring longer follow-up for meaningful survival outcomes. The conversation reveals growing adoption of these approaches in Colombian hospitals, particularly at major academic centers. Both experts stress the importance of treating all detected lesions when pursuing SBRT, referencing ORIOLE trial data showing outcomes with comprehensive versus partial treatment of metastatic sites.

Biographies:

Luis Salgado, MD, Urólogo Oncólogo, Jefe Servicio de Urologia, Clinica Universitaria Columbia, Bogotá, Colombia

Zachary Klaassen, MD, MSc, Urologic Oncologist, Assistant Professor of Surgery/Urology at the Medical College of Georgia at Augusta University, Wellstar MCG, Georgia Cancer Center, Augusta, GA



Related Content:

SCU 2025: Low-Volume Hormone-Sensitive Metastatic Disease – Treatment of the Primary and Metastasis-Directed Therapy: Against

SCU 2025: Low-Volume Hormone-Sensitive Metastatic Disease – Metastasis-Directed Therapy: In Favor

EAU 2023: Debate: Low-Volume Disease at Conventional Imaging, 5 Bone Metastases at PSMA PET/CT
Read the Full Video Transcript

Zachary Klaassen: Hi, and welcome to UroToday. We are in Cartagena, Colombia for the SCU 2025 annual meeting. We're delighted to be here, and I'm delighted to be joined by Dr. Luis Salgado who is a urological oncologist here in Colombia. Today, we're going to be talking about metastatic hormone-sensitive low-volume disease and the input for metastasis-directed therapy and what that evidence looks like. Luis, thanks so much for joining us on UroToday.

Luis Salgado: Thank you, Zach. Thank you. Happy to be here.

Zachary Klaassen: It's great to be here in Colombia. This meeting has been fantastic, very welcoming. Before we get into our discussion, maybe just lay out all these trials with metastatic hormone-sensitive prostate cancer. All with conventional imaging but now we live in the PSMA PET era, how do we interpret volume of disease based on conventional versus PSMA PET data?

Luis Salgado: Okay. Traditionally, we have conventional imaging for the metastasis in prostate cancer, but the era of PSMA, we have to... Many, many micrometastasis or volume is different for us.

Zachary Klaassen: Sure.

Luis Salgado: For me, it's very important, this area, because the interpreting the imaging or the metastasis is different for us.

Zachary Klaassen: Yeah, absolutely. I think we often see patients with metastatic hormone-sensitive disease, conventional, maybe low-volume PSMA PET, maybe high volume, and I agree. I think to interpret the data based on those differences is a challenge in 2025.

Luis Salgado: Yeah. It's very different, because we traditionally have three, four lesion or metastasis in bone, but in the PSMA, we have metastasis in visceral or many more.

Zachary Klaassen: Absolutely. Looking at the primary radiotherapy to the prostate for low-volume disease, we had STAMPEDE Arm H published several years ago. Maybe just tell our listeners what that survival benefit looked like in that trial for low-volume disease.

Luis Salgado: This part is very important in the Arm H, the STAMPEDE, because when we do radiotherapy in the primary from the prostate, we have results in benefits on survival in this area.

Zachary Klaassen: Yeah, exactly. We don't see that necessarily in the high volume, and so it's hard to-

Luis Salgado: Exactly. Only in the only low-

Zachary Klaassen: Low volume. Yeah. I think the data for oligometastatic SBRT is certainly occurring. There's a lot of interesting trials ongoing. We have some data looking at low volume SBRT. Maybe just walk our listeners through where that data comes from in those trials.

Luis Salgado: This area in the therapy is very important but carefully. Why? Because this is phase one, phase two, but in the... Only in the results of oncology, we need more time to do our results in survival OS. This is important because the therapy or MDT is very important to have overall results.

Zachary Klaassen: Yeah, absolutely. You're right, these trials take a long time to get meaningful results.

Luis Salgado: Exactly.

Zachary Klaassen: Prostate cancer-specific survival, overall survival. When we look at practice in America, there's a lot of SBRT to oligometastatic disease even though the data is still occurring. How is it in Colombia? What's the utilization of radiotherapy to the primary and SBRT to the metastasis?

Luis Salgado: It is growing up. It's growing up quickly, for me. It's very, very growing up. For me, it's important, but we have to do very careful and we need time, but in Colombia, it's growing up in many hospital. Especially in big hospital or university hospital, we have many, many treatment just like that.

Zachary Klaassen: Absolutely. I think too, for our listeners, a good take home message is if you're going to treat with SBRT, try to treat all of the lesions. We know some of the data previously from ORIOLE that if we treat all the lesions versus some of them, the benefit is better. Correct?


Luis Salgado: Yeah, it's correct. The benefit is necessary in this area. For me, it's important. I know we need time for this, in particularly, in therapy, but we need time, but it's important in these patients.

Zachary Klaassen: Yeah, absolutely. Great conversation, Luis. Any take home messages, concluding statements for our UroToday listeners?

Luis Salgado: Oh, we are very happy and welcome to Colombia, anytime.

Zachary Klaassen: That's fantastic. Thanks for joining us on UroToday.

Luis Salgado: Oh, thank you, Zach.