Radiotherapy in Men with De Novo Metastatic Prostate Cancer

Systemic therapy intensification has improved outcomes for patients with de novo metastatic prostate cancer. Retrospective studies highlighted the benefits of radiotherapy to the local tumor, prompting prospective evaluation via the HORRAD, STAMPEDE, and PEACE-1 trials. While the HORRAD trial suggested a trend toward improved survival, the STAMPEDE trial demonstrated a statistically significant overall survival benefit in patients with lower-risk or lower-volume disease. The PEACE-1 trial investigated local radiotherapy in the era of intensified systemic therapy. Benefits including improved radiographic progression-free survival, castrate resistance-free survival, and genitourinary side effects make local radiotherapy a valuable therapy for subgroups of patients.