The ARTO trial evaluated whether adding SBRT (metastasis-directed therapy to all sites) to abiraterone acetate plus ADT improved overall survival versus abiraterone acetate plus ADT alone in patients with oligometastatic castrate-resistant prostate cancer (≤3 metastatic sites, no prior systemic therapy for mCRPC), with a median follow-up of 53 months.
Median overall survival was 50 months in the control group vs not reached in the SBRT group (HR 0.55, 95% CI 0.33–0.92, p=0.021). Grade 3–4 infectious complications occurred in 5 control vs 0 SBRT patients; one treatment-related death (myocardial failure) occurred in the control group.
- Phase 2 trial with a relatively small sample (n=157); overall survival analysis was unplanned and power calculation was updated post-hoc. - Open-label design introduces potential performance bias. - No race or ethnicity data were collected, limiting generalizability.
In oligometastatic mCRPC with ≤3 sites, adding SBRT to abiraterone acetate plus ADT significantly improved overall survival at ~4 years of follow-up. Clinicians should consider MDT as part of the treatment strategy for eligible patients, pending confirmation in phase 3 trials.
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