Multiple courses of SBRT in oligoprogressive high volume metastatic prostate cancer: a case report

In very high metastatic prostate cancer the use of radiotherapy was reserved for palliative bone metastasis. In this case report we highlight that the use of the integration of aggressive medical and radiotherapy therapies can lead to great benefits. 80-year-old patient, KPS 100, no comorbidities. At the onset of the disease he was 73 years old (2017). Following the appearance and worsening of urinary disorders (urgency, frequency, nocturia) he performed a PSA measurement of 462.6 ng/ml. Subsequent prostate biopsy showed ADK Gleason 9 (5+4) in all samples. Choline PET staging highlighted pathological hypermetabolism throughout the prostate gland, multiple secondary lymph node and bone localizations over 20 sites; stage: cT3N1M1c. Chemotherapy with docetaxel, androgen deprivation therapy (ADT), androgen receptor signaling inhibitors (ARSI), stereotatic body radiotherapy (SBRT) to the prostate and 10 other bone and lymph node sites, plus radiometabolic therapy with lutetium led to complete remission of the disease. As of May 2026, the patient is alive and no evidence of disease, with a PSA level of zero and a negative PSMA PET scan. ECOG 1.