oCRPC and oHSPC

[PCaWarrior]

Aligns well with theory and trials. But how to get the 70%-80% higher? That's still a 20%-30% chance of the combo therapy not working.

Likelihood of Success Estimates

SBRT Alone:

We estimate a moderate likelihood (approximately 50–60%) that SBRT alone will achieve excellent tumor control—i.e. eradication of visible metastases—and extend life while maintaining manageable toxicity. However, its effectiveness is limited by untreated microscopic disease.

SBRT + ADT:

For oligometastatic hormone-sensitive prostate cancer, combining SBRT with androgen deprivation therapy (ADT) offers a higher chance, roughly 65–75%, of achieving excellent tumor control and extending survival with manageable toxicity. In castration-resistant cases, where ADT is already in place, the incremental benefit may be less pronounced.

SBRT + Olaparib:

In patients with castration-resistant disease, especially those harboring BRCA or other DNA repair mutations, SBRT combined with olaparib may yield a success likelihood of about 60–70% for metastatic eradication and life extension. In hormone-sensitive cases without these mutations, the benefit would be more modest—around 55–65%—since the systemic impact of olaparib is less pronounced without a DNA repair defect.

Full Combination (BAT + SBRT + Olaparib + ADT + Doxazosin):

With all modalities integrated, the multi-target approach is estimated to have a moderate-high likelihood (approximately 70–80%) of achieving excellent tumor control and extending life, while maintaining manageable toxicity. This regimen leverages both local control and systemic effects, making it potentially more effective than any two-modality approach, albeit at the cost of increased complexity and careful management of overlapping toxicities. My note: I have used this combo with minimal side effects. The only one that was noticeable to me was temporary minor fatigue.