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

Source: https://onco.cc/ideas/idea-psma-pet-guided-mdt/  
OnCo record `idea-psma-pet-guided-mdt` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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

## Summary

The idea is to use PSMA PET after prostate surgery to find the few sites of recurrence and treat each with stereotactic radiotherapy plus short-course androgen deprivation. The oligometastatic state is real in prostate cancer, the radiotherapy is ablative and cheap, and PSMA PET removes the staging blind spot that undermined older trials such as ORIOLE and STOMP. The hypothesis is better metastasis-free and ADT-free survival than systemic therapy alone, though whether it changes survival or merely postpones hormone therapy is unproven. The test is a randomised phase 3 with PSMA PET at baseline and progression and ctDNA as a stratifier; PEACE V/STORM and NRG GU011 are under way, so it is being tested at scale.

## Fields

- Kind: Idea
- Last checked: 2026-09-06
- 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.
- Proposed test: 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

## Sources

- ORIOLE: observation versus stereotactic ablative radiation for oligometastatic prostate cancer (JAMA Oncology 2020): https://doi.org/10.1001/jamaoncol.2020.0147

## Connected records

- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- ideas: [A test to tell true oligometastatic disease from hidden widespread spread](https://onco.cc/ideas/idea-bio2-oligometastatic-signature/), [Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer](https://onco.cc/ideas/idea-prostate-randomise-the-sequence-not-only-the-drugs/), [When the blood test is positive, hunt for the lesion with sensitive imaging](https://onco.cc/ideas/idea-bio2-localise-the-mrd/)
- cancers: [Biochemical recurrence of prostate cancer](https://onco.cc/cancers/prostate-bcr/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [PSMA PET](https://onco.cc/technologies/psma-pet/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- terms: [Biochemical recurrence (BCR)](https://onco.cc/terms/biochemical-recurrence/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/)
- key papers: [Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial](https://onco.cc/key-papers/paper-phillips-jama-oncol/)
- bottlenecks: [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/)

---
JSON: https://onco.cc/api/v1/entities/idea-psma-pet-guided-mdt.json