13 • Additional information is available from two uncontrolled phase II trials, both of which used prostate-specic PET scanning: • In one trial 72 patients with a rising PSA after denitive local therapy and negative conventional imaging, who all then underwent prostate-specic membrane antigen (PSMA)- PET/CT to detect and localize oligometastatic disease . Overall, 38 were found to have a PSMAdetected oligometastatic recurrence that was thought amenable to metastasis-directed therapy, 92 percent of which were nodal only, the remainder skeletal. At a median follow-up of 15.9 months, 22 percent of the 37 patients who were treated with SBRT (n = 27) or surgery (n = 10) normalized their PSA. Median time to PSA progression (freedom from ADT) was 17.7 months. • The OLIGOPELVIS GETUG P076 trial studied highdose salvage radiotherapy plus short-term androgen deprivation therapy in 67 patients with isolated oligometastatic pelvic node relapse detected by PET CT after treatment for localized disease. 35 had previously received prostate radiotherapy. After a median follow-up of 49 months, median biochemical relapse-free survival was 25.9 months, 58 percent remained progression free at 9-10 three years. The benets of stereotactic body RT (SBRT) for treatment of oligometastatic disease can be illustrated by the following reports: • The phase II Observation versus Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer trial (The ORIOLE Phase 2 Randomized Clinical Trial) randomly assigned 54 males with recurrent, hormone-sensitive, oligometastatic prostate cancer (three or fewer lesions as determined by conventional imaging) to observation and no further treatment for six months or to SBRT to the metastatic sites outside of the prostate that were detected by conventional imaging. Six months after randomization, progression (dened as a PSA increase, radiographic progression on conventional imaging, or symptomatic decline) was observed in 19 percent of those undergoing SBRT versus 61 percent of the control group. The patients randomized to SBRT all underwent PET CT using highly sensitive, prostate cancerspecic PSMA-based radionuclides at baseline and at six months. • In another randomized phase II study (SABRCOMET) of 99 patients with cancer of a variety of primary tumors (16 with prostate cancer) and up to ve metastatic lesions to any site (65 had bone metastases), when compared with palliative care alone (which included standard-fractionation RT with or without systemic chemotherapy), the use of SBRT for treatment of oligometastatic disease was associated with a signicant improvement in ve-year overall survival (42 versus 18 percent, p = 0.006) • A meta-analysis of 23 observational studies of SBRT for oligometastatic prostate cancer recurrence concluded that local control was excellent, with minimal severe or late toxicity, and among the ve studies reporting this outcome, the average duration of ADT-free survival was approximately 5-6 20 months. ADT-free survival UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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