Local radiotherapy (RT) in hormone-sensitive metastatic prostate cancer (mHSPC) can benefit patients with high-burden disease, not just those with low metastatic loads.
Evidence from HORRAD, STAMPEDE, and PEACE-1 shows improved local control, fewer genitourinary complications, and delayed castration resistance, though a clear overall survival benefit remains unproven.
The “seed-and-soil” theory supports disrupting metastatic spread by treating the primary tumor, while synergy with ADT or ARPIs further bolsters effectiveness. Dr. Karim Fizazi (Institut Gustave Roussy) has shaped risk stratification in mHSPC, guiding RT’s integration into multimodal treatments.
Although more trials are needed, RT appears valuable for symptomatic relief and disease control in selected high-burden cases.
Six big things in metastatic prostate cancer