OnCo
ideasIdea

PSMA-PET-guided metastasis-directed therapy as a curative strategy in oligorecurrent prostate cancer

When PSMA PET finds only a few spots after surgery, zap each spot with focused radiation and delay or avoid lifelong hormone therapy.

ORIOLE and STOMP showed SBRT to PSMA/choline-PET-detected oligometastases delays progression; PSMA PET now finds recurrence at PSA <0.5. Whether MDT changes survival or merely postpones ADT is unproven; phase 3 trials (e.g., PEACE V/STORM, NRG GU011) are underway.

Confidence
50%–75%likelyOnCo editors (initial estimate), 2026-09-07 · Randomised MDT trials with PSMA PET are underway; SBRT benefit in oligometastatic disease is established.
Hypothesis
PSMA-PET-directed SBRT to ≤5 metastases, with short-course ADT, improves metastasis-free and ADT-free survival versus systemic therapy alone in oligorecurrent disease.
Rationale
Oligometastatic state is real in prostate cancer; SBRT is ablative and cheap; PSMA PET removes the staging blind spot that undermined older trials.
What would test it
Randomised phase 3 with PSMA PET at baseline and progression, ADT-free survival and MFS endpoints, ctDNA and PSMA-PET total-volume as stratifiers.
Maturity
being tested at scale

Connected

8top

Pages like this

not linked directly; found by shared links

cancers

1
Prostate cancer

technologies

2
PSMA PETSBRT / SABR (stereotactic radiotherapy)

terms

2
Biochemical recurrence (BCR)Oligometastatic disease

ideas

2
A test to tell true oligometastatic disease from hidden widespread spreadWhen the blood test is positive, hunt for the lesion with sensitive imaging

bottlenecks

1
Metastasis is understood least and studied last