Background:
Localized prostate cancer (PC), one of the most diagnosed cancers among men, has a relatively favorable prognosis; Metastatic PC, however, has significantly lower survivorship. Standard treatments for metastatic PC include androgen deprivation therapy (ADT), but this treatment diminishes the patient’s quality of life, and frequently progresses to castration-resistant disease. There is therefore interest in determining when ADT can be postponed or avoided. Stereotactic body radiation therapy (SBRT) has shown promise in managing the oligometastatic disease setting.
Case Presentation:
This report describes a patient with metastatic PC who underwent a total of nine rounds of SBRT with limited ADT. Initially diagnosed in 2012 with pT3a prostate adenocarcinoma, the patient was treated with surgery and radiation without ADT. The first PSA relapse occurred 6 years post-diagnosis with metastatic foci in the rib cage and spine. The patient refused systemic ADT and opted for local palliative radiotherapy with successful clearance. Novel metastatic foci were identified 10 months later, again treated with SBRT alone for a rapid biochemical response. PSA steadily rose until July 2022 when imaging revealed the spinal metastasis recurred plus novel nodal positivity. Finally, ADT was administered alongside SBRT, resulting in undetectable PSA levels by September 2022. The patient has since maintained biochemical remission with eugonadal testosterone levels.
Conclusions:
While ADT is crucial for metastatic PC, its adverse effects necessitate alternative strategies. This case demonstrates the potential of metastasis-directed radiotherapy like SBRT in managing metastatic lesions, delaying or reducing the need for ADT.