Comprehensive Versus Primary Tumor Radiotherapy in Oligometastatic Prostate Cancer

Exclusion Criteria

• •Small cell carcinoma of the prostate or prostate sarcoma.
• •The primary focus has received external radiation therapy, brachytherapy, and radical prostatectomy.
• •Received non-endocrine systemic therapies prior to enrollment (e.g., chemotherapy, targeted therapy, radionuclide therapy).
• •Metastatic castration-resistant prostate cancer (mCRPC) phase (EAU Guidelines\*).
• •Presence of visceral metastases (e.g., liver, lung).
• •Previous bilateral orchiectomy.
• •Comorbidities: Severe comorbidities affecting survival or treatment tolerance, including: Cardiovascular diseases (NYHA Class III/IV heart failure, uncontrolled arrhythmias); Renal insufficiency (eGFR \<30 mL/min/1.73m\^2); Neuropsychiatric disorders impairing protocol compliance.
• •* Definition of mCRPC (EAU Guidelines):
• •Metastatic castration-resistant prostate cancer (mCRPC) is defined as disease progression despite serum testosterone levels below 50 ng/dL (or 1.7 nmol/L), concurrently with one or more of the following:
• •1. PSA progression: A sequence of at least three consecutive rises in PSA, measured ≥1 week apart, resulting in a ≥50% increase from the nadir (lowest) level, with a minimum absolute PSA value \>2 ng/mL.
• •2. Radiographic progression: The appearance of new lesions, defined as either:
• •* ≥2 new lesions on bone scan (Tc-99m bone scintigraphy), or
• •* New measurable soft tissue lesions according to RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria.
• •3. Unequivocal clinical progression: Clinical progression in the absence of concurrent PSA or radiographic progression should be viewed with suspicion and mandates further investigation to confirm disease progression.