Prostate- and metastases-directed radiotherapy in de novo low-volume metastatic prostate cancer

Background - The role of radiotherapy in de novo low-volume metastatic prostate cancer (LVmPC) is constantly evolving and still offers considerable potential for further optimization. Rising interest in this topic demands further investigations in this specific patient cohort. We report on clinical...

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Hauptverfasser: Bolten, Jan-Hendrik (VerfasserIn) , Weykamp, Fabian (VerfasserIn) , Grott, Christoph A. (VerfasserIn) , Neugebauer, David (VerfasserIn) , Wessel, Lars (VerfasserIn) , Englert, Felix Hermann (VerfasserIn) , Valentini, Justus (VerfasserIn) , Görtz, Magdalena (VerfasserIn) , Zschäbitz, Stefanie (VerfasserIn) , Huber, Johannes (VerfasserIn) , Winter, Erik (VerfasserIn) , Debus, Jürgen (VerfasserIn) , Liermann, Jakob (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: January 2026
In: Clinical and translational radiation oncology
Year: 2026, Jahrgang: 56, Pages: 1-7
ISSN:2405-6308
DOI:10.1016/j.ctro.2025.101072
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.ctro.2025.101072
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2405630825001648
Volltext
Verfasserangaben:Jan-Hendrik Bolten, Fabian Weykamp, Christoph Grott, David Neugebauer, Lars Wessel, Felix H. Englert, Justus Valentini, Magdalena Goertz, Stephanie Zschaebitz, Johannes Huber, Erik Winter, Juergen Debus, Jakob Liermann

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520 |a Background - The role of radiotherapy in de novo low-volume metastatic prostate cancer (LVmPC) is constantly evolving and still offers considerable potential for further optimization. Rising interest in this topic demands further investigations in this specific patient cohort. We report on clinical outcomes and toxicity of combined prostate-directed (PDRT) and metastasis-directed radiotherapy (MDRT) with ablative dose concepts in patients with de novo LVmPC. - Methods - We retrospectively analyzed 21 patients with LVmPC treated with PDRT plus MDRT between 2018 and 2025 in addition to systemic treatment. Staging was performed with PSMA-PET/CT imaging (n = 19/21). Radiotherapy included high-dose external beam PDRT and MDRT to all detectable bone and nodal metastases. Toxicity was assessed using CTCAE v5.0, IPSS, and EPIC-26 questionnaires. Oncologic outcomes included biochemical recurrence-free survival, PSA response, and time to next-line systemic therapy. - Results - Additional radiotherapy of all tumor sites in LVmPC was well tolerated; no grade ≥ III gastrointestinal or genitourinary toxicity occurred. The most common adverse events were associated with hormonal therapy. Quality of life remained stable or improved in urinary and bowel domains. Undetectable PSA was achieved in 67 % of patients after radiotherapy in addition to systemic therapy. 14 % of the patients developed biochemical recurrence within 40 months after radiotherapy completion. - Conclusion - Combined PDRT and MDRT in addition to standard of care in patients with de novo LVmPC is feasible, well tolerated, and associated with promising biochemical control. Further prospective studies with larger patient cohorts integrating PSMA-PET/CT and other risk stratification factors are warranted to better define which patient subgroups benefit most from additional radiotherapy. 
650 4 |a Excellent tolerability of ablative radiotherapy of all PSMA-PET positive tumor manifestations in low-volume disease of oligometastatic prostate cancer 
650 4 |a Further stratification in low volume disease of oligometastatic prostate cancer is needed 
650 4 |a Importance of PSMA-PET-Staging in oligometastatic prostate cancer 
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