Kicking the can down the road: stereotactic body radiotherapy’s role in prolonging systemic treatment efficacy in metastatic castration-resistant prostate cancer

The role of stereotactic body radiotherapy (SBRT) for patients with prostate cancer is well established. Also in patients with hormone-sensitive metastatic disease, SBRT is an attractive option for both patients with synchronous disease or metachronous oligorecurrent lesions. Castration-resistant disease is a challenging scenario, for its heterogeneous presentation and for the need for a careful risk-benefit balance. Patients are often burdened from systemic agents and metastasis-directed approaches are less reported, although available experiences collect promising outcomes. The evidence summarized in this review supports SBRT for patients with mCRPC disease, with promising results in terms of disease control and delay of new systemic agents, with negligible toxicity. The low level of evidence highlights the need for well-designed prospective trials to further investigate this approach.