Can high-precision radiation change how we treat metastatic prostate cancer? In this episode, I’m joined by Ronald C. Chen, MD, MPH—radiation oncologist, national guideline author (AUA/ASCO), and clinical-trial leader with 170+ publications—to unpack stereotactic body radiation therapy (SBRT) for disease that has spread to lymph nodes, bones, and beyond. We get practical about who benefits, where SBRT shines, and how to balance treatment intensity with quality of life.
SBRT offers highly focused, short-course radiation that can control limited (“oligo-”) metastatic prostate cancer and delay systemic therapy for many men. Dr. Chen explains when to treat individual nodes/bone lesions versus comprehensive nodal fields, how anatomy determines dose/fraction choices (often 3–5 treatments), and why modern SBRT sometimes reduces the need for concurrent hormone therapy. We cover salvage options after prior radiation (brachytherapy seeds, HIFU, cryo, repeat SBRT, or salvage prostatectomy), the role and limits of PSMA PET, fracture risk and bone health (DEXA), and the evolving data—including the large NRG-GU013 trial—for higher-risk disease. Throughout, we emphasize shared decision-making, realistic expectations, and considering clinical trials when data are evolving.
00:00 – Can SBRT change metastatic prostate cancer care? Meet Dr. Ron Chen.
01:00 – Disclaimer: Views are Dr. Geo’s and guests’—independent of NYU Langone.
07:00 – Recurrence scenarios: prostate-only, nodal, or bone/other; why catching early matters.
12:00 – Five salvage options after prostate radiation: seeds (brachytherapy), HIFU, cryo, SBRT (focal or whole-gland), or salvage prostatectomy.
19:00 – Nodal relapse: treat all pelvic nodes + ADT ± abiraterone vs. SBRT to a few nodes only—how patient priorities drive the plan.
26:30 – Oligometastasis: SBRT alone can control disease for many men ~2+ years on average, delaying hormones.
30:00 – Fractions: why 3–5 treatments is typical and how adjacent bowel/organ anatomy sets the pace.
31:00 – SBRT in 2 fractions for select primary cases looks promising; high-risk SBRT under study (NRG-GU013).
37:00 – Bone mets: SBRT preferred; understanding fracture risk (tumor size, dose, shrinkage).
40:00 – DEXA before ADT; spine SBRT can spare the spinal cord with modern planning.
48:00 – Clavicle/hilar nodes: SBRT near lung/heart/esophagus—safe with careful dose constraints.
56:00 – Why clinical trials matter for “how long on hormones?” and other open questions.
57:00 – Soft-tissue mets (liver/brain): SBRT can help, often alongside systemic therapy.
59:00 – Parting advice: early detection, close follow-up, and hopeful trajectory of care.
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⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.
