High-Risk Metachronous Oligometastatic Prostate Cancer Trial

Inclusion criteria

• ✓. ≥18 years of age (or the local legal age of consent).
• ✓. Patient must have at least one and up to three asymptomatic metastatic tumor(s) of the bone, soft tissue, or extra-pelvic nodal region each \< 5 cm or \< 250 cm3 that develop within the past 6-months that are seen on imaging. A nodal lesion is defined to include nodal conglomerates located in the same nodal chain such that they can be treated in one SABR field. Up to five lesions are allowed on advanced functional imaging such as fluciclovine (Axumin), choline or Prostate Specific Membrane Antigen (PSMA) PET-CT scan.
• ✓. CT or MRI scan within 6 months of enrollment
• ✓. Bone scan within 6 months of enrollment
• ✓. Fluciclovine (Axumin), choline, or PSMA PET-CT scan within 6 months of enrollment (PET-CT scan is reasonable for study entry imaging as an alternative to CT/MRI scan and bone scan)
• ✓. Must have a high-risk pathogenic mutation (TP53, BRCA1/2, PALB2, ATM, BRIP1, CHEK2, FANCA, RAD51B, RAD54L, MUTYH) by next generation sequencing. ATM mutation enrollment will be capped at 5% of the overall population.
• ✓. Histologic confirmation of prostate adenocarcinoma (primary or metastatic tumor).
• ✓. Patient may have had prior systemic therapy and/or ADT so long as testosterone is \> 100 ng/dl prior to enrollment