Prostate-directed Radiotherapy in Selected Patients With Metastatic Castration-sensitive Prostate Cancer: A Real-world Case Series.

Authors

Nobuki Furubayashi, Takaaki Nakashima, Ryuji Uehara, Takehito Kojima, Yasuhiro Nakano, Akari Kataoka, Madoka Abe, Takahito Negishi

Published in

In vivo (Athens, Greece). Volume 40. Issue 6. Pages 3843-3853.

Abstract

Prostate-directed radiotherapy (RT) improves outcomes in selected patients with metastatic castration-sensitive prostate cancer (mCSPC), particularly those with low metastatic burden. However, real-world information regarding its use after response to systemic therapy remains limited. This study describes the treatment characteristics, safety, and clinical course of selected patients with mCSPC who received prostate-directed RT.
We retrospectively reviewed an institutional RT database containing 396 patients who initiated prostate-directed RT between April 2015 and March 2026. Thirteen patients had mCSPC at RT initiation and were included. Prostate-directed RT was considered after a marked prostate-specific antigen (PSA) decline and confirmation of no radiographic progression during first-line systemic therapy; no prespecified PSA threshold was used. Patient characteristics, RT details, RT-related adverse events, and clinical outcomes after RT completion were evaluated.
Eight patients had low-volume and five had high-volume disease. The median interval from initiation of first-line systemic therapy to RT was 8.4 months. The median PSA decline before RT was 99.9% (interquartile range=98.9-99.9%), and the median PSA level before RT was 0.028 ng/ml. All patients received intensity-modulated RT, and residual metastatic lesions were included in the RT target volume in six patients. All patients completed RT. No grade ≥2 acute genitourinary or gastrointestinal toxicity was observed, and no late RT-related toxicity occurred among the 11 patients evaluable for late toxicity. During follow-up (median, 39.6 months) after RT, four patients developed castration-resistant disease and four experienced radiographic progression. No post-RT local events or prostate cancer-specific deaths occurred; one patient died of an unrelated cause.
In this small, highly selected cohort of patients demonstrating favorable initial responses to systemic therapy, prostate-directed RT was feasible and well tolerated, with no grade ≥2 acute RT-related toxicity, no late toxicity among evaluable patients, and no local events. Comparative efficacy cannot be determined because of the retrospective design, small sample size, and absence of a non-RT control group.

PMID:
42957244
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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