I’d zap that.

Here’s a great summary of the current data behind prostate-directed radiation in the setting of low-volume metastatic prostate cancer. An important takeaway is an emphasis on minimizing the toxicity of this non-curative therapy. Interestingly, prospective STAMPEDE data demonstrates a 2% absolute decrease in grade 3+ toxicity at two years with the addition of radiation. This could be because many patients received only 6 treatments (of 6 Gy weekly), and none received over 20 treatments (of 2.75 Gy daily). How does this stack up against other currently approved treatment options for low-volume M1 disease? Glad you asked. The expected absolute benefit in overall survival with the addition of abiraterone is 4% at an incredible average cost of >$300K. Those numbers for 6 prostate radiation treatments are an 8% improvement at <$20K. So do we leave the oligomets untreated? That’s a question for the next STAMPEDE arm so, for now, it’s not wrong either way. TBL: Hypo- or ultra-hypofractionated radiation to the prostate should currently be considered the standard, most effective, and least toxic life-prolonging therapy for low-volume metastatic prostate cancer. | Choudhury, Int J Radiat Oncol Biol Phys 2019