TERPS Trial for de Novo Oligometastic Prostate Cancer

Inclusion criteria

• Patient must have at least one and up to three asymptomatic metastatic tumor(s) of the bone or soft tissue (with at least one bone metastasis) develop within the past 6-months that are seen on imaging. Up to five lesions are allowed on advanced functional imaging such as fluciclovine (Axumin), choline or 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)
• Histologic confirmation of malignancy (primary or metastatic tumor).
• Patient may have had prior systemic therapy and/or ADT associated with treatment within 9-months of enrollment.
• PSA \> 0.5 but \<100.
• Patient must be ≥ 18 years of age.
• Patient must have a life expectancy ≥ 12 months.
• Patient must have an ECOG performance status ≤ 2.
• Patient must have the ability to understand and the willingness to sign a written informed consent document

Exclusion criteria

• Castration-resistant prostate cancer (CRPC).
• Prior radiation therapy to an overlapping site of a target lesion that would preclude further radiation therapy
• Spinal cord compression or impending spinal cord compression.
• Suspected pulmonary and/or liver metastases (greater \>10 mm in largest axis).
• Patient receiving any other investigational agents.
• Inability to receive any form of systemic therapy in the opinion of a treating medical oncologist .
• Unable to lie flat during or tolerate PET/MRI, PET/CT or SABR.
• No radiographical evidence of cranial metastasis.
• Refusal to sign informed consent.