Short-Course ADT + Apalutamide ± Abiraterone with SBRT Yields ≥85% 18-mo PFS in PSMA-PET Oligometastatic Prostate Cancer

In the randomized phase II Metacure B2 study (NCT03436654) and its expansion (n = 36), men with PSMA-PET-detected metachronous oligometastatic, hormone-sensitive prostate cancer received stereotactic body radiotherapy to all lesions plus 6–10 months of androgen-axis blockade: ADT + apalutamide (AR antagonist) alone or with abiraterone/prednisone (CYP17 inhibition). At 12 months, after testosterone recovery in ~55% of patients, PSA was <0.1 ng/mL in 79-100% of patients. 18-month progression-free survival was 100% for ADT + apalutamide (cohort B2), 85% for ADT+apalutamide (expansion), and 60% for ADT + apulutamide + abiraterone/prednisone, with median PFS and radiographic PFS not yet reached. Grade 3 toxicity was rare (1/36, lymphopenia).