Testosterone resurgence.

Headline: Metastasis-directed radiation prolongs time off androgen deprivation therapy (ADT).

The Study: We love this one, and your patients with oligometastatic prostate cancer will, too. EXTEND is a massive phase 2 basket trial randomizing patients with all types of metastatic cancer to +/- the addition of mets-directed local therapy (MDT), typically radiation. The prostate sub-study was smart by enrolling men with 5 or fewer mets on ADT and planning a break from ADT at 6 months after enrollment and re-starting upon progression. ADT was an LHRH agonist/antagonist with or without a second-generation androgen receptor targeted agent (aka SART such as abiraterone or enzalutamide). The primary endpoint of progression or death was slashed as expected with the addition of MDT (HR 0.25). Those getting an SART also had a much lower risk of progression or death (HR 0.36). What’s more novel—and more meaningful to patients—is significant prolongation of time free from disease while maintaining a normal testosterone level (>150 ng/dl).

TBL: Radiation for prostate cancer oligomets can help men take longer ADT breaks while remaining free from cancer progression. | Tang, ASTRO 2022