Prostate
MDT/SBRT evidence is maturing across oligomet prostate states, with ARTO providing the first RCT OS signal, but de novo HSPC and patient selection remain open.
EAU 2026: MDT/SBRT in oligometastatic prostate cancer (Fonteyne review)
ForOligometastatic prostate cancer (oligorecurrent HSPC-predominant)
TL;DRMDT/SBRT delays progression across oligomet prostate states; only ARTO suggests an OS benefit; de novo HSPC and patient selection remain unsettled.
vs leading data
- ARTO (castration-resistant oligomet): MDT plus SOC improved PFS, OS and PCSS; per Fonteyne the first RCT signal of an OS benefit (no effect sizes reported in source)
8 details 5 trials watching
Methods
- 🔍 EAU 2026 thematic-session review (Fonteyne, Ghent radonc) of MDT/SBRT evidence across oligomet prostate states, not a single trial
- 🔍 SOLAR (N=21, synchronous): tested ADT discontinuation after MDT, tracking testosterone recovery with sustained low PSA; outcomes favored synchronous vs SATURN (metachronous), hypothesis-generating
Results
- 📊 Oligorecurrent HSPC carries most data: STOMP, ORIOLE showed high local control, delayed progression, minimal toxicity (no effect sizes reported in source)
- 📊 RADIOSA: ADT plus MDT improved PFS vs MDT alone (no effect size reported in source)
- 📊 WOLVERINE: MDT added to SOC improved PFS, rPFS and delayed CRPC, but no significant OS benefit (no effect sizes reported in source)
Critique
- ⚠️ De novo oligomet HSPC: high-level evidence lacking; awaiting STAMPEDE2 (SBRT), PLATON, TERPS, OLIGOPRESTO
- ⚠️ Radioligand plus MDT unproven: RAVENS (Ra-223 plus MDT) did not improve PFS or MFS vs MDT alone; LUNAR (Lu-177) ongoing
- ⚠️ Selection gates benefit, not lesion count alone: PSMA-PET burden (PP3 retrospective) may refine OS stratification; systemic therapy alone remains standard for most pts
Open questions
- Does MDT improve OS beyond PFS in oligometastatic prostate? recruiting Comprehensive Versus Primary Tumor Radiotherapy in Oligometastatic Prostate Cancer Phase NAn=390 · primary completion 2027-01 · phase III; MDRT vs primary RT alone; survival endpoint
- Role of MDT in de novo oligometastatic HSPC active Prostate-cancer Treatment Using Stereotactic Radiotherapy for Oligometastases Ablation in Hormone-sensitive Patients Phase 3n=550 · primary completion 2026-06 · phase III SBRT to all oligomets in M1 HSPC; de novo eligiblen=122 · primary completion 2028-07 · phase II de novo oligomet; prostate + metastatic SABR
- Biomarker/PSMA-PET selection beyond lesion count n=60 · primary completion 2025-12 · PSMA-PET only selection; conventional imaging negativerecruiting Phase II Non-Randomized Study Evaluating POSLUMA-PSMA PET Response After Oligo- Metastatic/Progressive-directed Treatment With Radiotherapy (PROMPT-R) Phase 2n=50 · primary completion 2028-05 · PSMA-PET + ctDNA as response biomarkers post-MDT
📚 Sources · 📄 1 paper
EAU 2026: What Evidence Do We Have from Intensification with SBRT?
Abstract
EAU 2026 Hormone sensitive metastatic prostate cancer, metastasis-directed therapy (MDT) in oligometastatic prostate cancer, STOMP and ORIOLE.
📝 https://www.urotoday.com/conference-highlights/eau-2026/eau-2026-prostate-cancer/167454-eau-2026-what-evidence-do-we-have-from-intensification-with-sbrt.html