Ablative MDT (PSMA-PET–guided SBRT) prolongs time to PSA progression in oligometastatic CRPC (interim Phase II)

In a single-centre randomized Phase II trial, PSMA-PET–guided metastasis-directed therapy (MDT; ablative radiotherapy to ≤5 PSMA-positive bone/lymph node metastases) was tested in castration-resistant prostate cancer with PSA progression on ADT ± androgen receptor–targeted therapy, with no mandated systemic-therapy change (MDT n=18; observation n=12; NCT04141709). PSA progression within 1 year occurred in 44% with MDT vs 75% with observation (p=0.14), while median time to PSA progression improved to 12.4 vs 2.9 months (p=0.03). Safety outcomes were not reported in this interim analysis; compared with the “standard” approach of switching/escalating systemic therapy at CRPC progression (typically yielding radiographic PFS in the ~4–9 month range depending on agent/line), this strategy is notable mainly for its potential to buy time without immediate systemic-therapy change—though the primary endpoint signal was not statistically significant at this interim look.