Radiation Therapy For Oligometastatic Prostate Cancer
- Metastatic prostate cancer means that the cancer has spread beyond the prostate. A specific type of metastatic disease, known as oligometastatic prostate cancer, occurs when the cancer has spread only to a few select spots. This type of cancer may benefit particularly from radiation.
- The most common approach is using something known as stereotactic body radiation therapy (SBRT). This is an advanced form of radiation that delivers very high doses directly to the tumor with extreme accuracy.
- SBRT can help delay the need for systemic therapy like hormone therapy, slow cancer growth, improve survival, and reduce side effects.
- If your prostate gland still has cancer, your doctor might also recommend radiation to the prostate — even if the cancer has already spread.
The distinction is important because oligometastatic disease may behave differently than cancer that has spread widely. In fact, research shows that when cancer is limited to a few spots, it may respond better to targeted treatments like radiation.
Read MoreRadiation’s Changing Role
For many years, if prostate cancer had spread, treatment focused only on systemic therapy — medicine that travels throughout the body, such as hormone therapy (androgen deprivation therapy (ADT) +/- androgen receptor pathway inhibitor (ARPI). Radiation was usually given only for symptom relief, like easing bone pain. But now, studies show that treating all the visible cancer spots with radiation can slow the disease and, in some cases, help patients live longer.This type of treatment is called metastasis-directed therapy (MDT). The goal is to attack each cancer site so the disease doesn’t spread further.
What Does The Research Show?
Recent clinical trials have changed the way doctors think about oligometastatic prostate cancer and radiation.
Some notable developments include the following:
- STOMP Trial (2018): Men with only a few metastases who received focused treatment like radiation went much longer before needing hormone therapy compared to men who were just observed.
- ORIOLE Trial (2020): Men who got radiation to all visible cancer spots had better control of their disease and fewer new metastases compared to those who didn’t get radiation.
- EXTEND Trial (2025): The addition of radiation to all visible cancer spots to hormonal therapy had better control of their disease compared to those who received hormonal therapy alone.
Targeted radiation can make a real difference, especially when the cancer has spread to a few spots in the body.
The Benefits Of Radiation Therapy
The most common approach for oligometastatic disease is called stereotactic body radiation therapy (SBRT). This is an advanced form of radiation that delivers very high doses directly to the tumor with extreme accuracy.
SBRT has several benefits, including:
- Short treatment time (most patients need only one to five treatments, instead of weeks of daily sessions)
- Very precise (SBRT uses imaging and motion tracking to target just the cancer, sparing healthy tissue)
- Outpatient procedure (there is no hospital stay)
- SBRT can be used for bone metastases, lymph node metastases, and sometimes other small areas.
Your medical team might recommend this approach for several reasons. It can delay the need for hormone therapy, slow cancer growth, improve survival, and lead to fewer side effects.
“There are some patients for whom the medication therapy [systemic therapy] is something they don’t want to pursue due to the side effects. They’re very concerned about having to go on this medication, which impacts their testosterone, their male hormone, which feeds prostate cancer,” Dr. Vapiwala explains, regarding why some patients may opt for radiation.
Potential Side Effects
Most patients tolerate SBRT very well, and side effects depend on where the cancer is located.
For example, those with bone metastases might feel a brief pain “flare” for a few days after treatment.
When cancer has spread to lymph nodes in the pelvic area, they may experience mild bowel or bladder irritation for a short time.
Those with spinal lesions may have a risk of nerve irritation, but doctors use strict safety measures to avoid this.
Most side effects are mild and temporary. Serious complications are uncommon, especially when the treatment is done at an experienced center.
Am I A Candidate For Radiation?
Radiation for oligometastatic disease isn’t for everyone.
You might be a good candidate if you:
- Does not have widespread cancer in multiple areas
- Have five or fewer metastatic spots
- Are in good overall health and able to undergo treatment
- Have a controlled primary prostate tumor (or will receive treatment for the prostate)
- Your doctor may recommend an advanced scan, such as a PSMA PET scan, to check exactly where the cancer is before deciding
Should The Prostate Be Treated Too?
If your prostate gland still has cancer, your doctor might also recommend radiation to the prostate — even if the cancer has already spread. Studies have shown that treating the primary tumor in men with a small number of metastases can improve survival when combined with hormone therapy. This usually involves a different type of radiation delivered over several weeks. Some patients get both treatments: radiation to the prostate and SBRT to distant spots.
Questions To Ask Your Doctor
- How many spots has my cancer spread to? Is it considered oligometastatic prostate cancer?
- Am I a candidate for SBRT or other local treatments?
- Should we also treat the prostate?
- How will radiation fit with other treatments like hormone therapy?
- What side effects should I expect?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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