Response to “Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration‐resistant prostate cancer patients – A closer inspection will improve your vision”

We would like to thank Onal C et al. for the interest in our publication on the use of SBRT to postpone escalation of systemic treatment of castration-resistant prostate cancer [[1]Baron D. Pasquier D. Pace-Loscos T. Vandendorpe B. Schiappa R. Ortholan C. et al.Stereotactic body radiation therapy to postpone systemic therapy escalation for castrationresistant prostate cancer: a multicenter retrospective analysis.Clin Transl Radiat Oncol. 2024; 45100710PubMed Google Scholar]. The imaging modality is a crucial point for staging the oligometastatic patient, as shown in the retrospective analysis by Fendler et al [[2]Fendler W.P. Weber M. Iravani A. Hofman M.S. Calais J. Czernin J. et al.Prostatespecific membrane antigen ligand positron emission tomography in men with nonmetastatic castration-resistant prostate cancer.Clin Cancer Res. 2019; 25: 7448-7454Crossref PubMed Scopus (183) Google Scholar]. Current prospective studies require specific imaging modalities to answer this question. However, in our retrospective and multicenter analysis, we were not able to provide robust data on this point. Indeed, patients were included over a period of more than 10 years, during which imaging recommendations at the time of diagnosis and follow-up, as well as the imaging modalities themselves, evolved. Logically, we performed more PSMA-PET/CT or CHOLINE-PET/CT staging during the last years of inclusion. The management of patients with metastatic castration-resistant prostate cancer is a hot topic. As Onal C et al. pointed out in their two studies [3Onal C. Ozyigit G. Oymak E. Guler O.C. Tilki B. Hurmuz P. et al.Stereotactic radiotherapy to oligoprogressive lesions detected with (68)Ga-PSMA-PET/CT in castrationresistant prostate cancer patients.Eur J Nucl Med Mol Imaging. 2021; 48: 3683-3692Crossref PubMed Scopus (18) Google Scholar, 4Onal C. Kose F. Ozyigit G. Aksoy S. Oymak E. Muallaoglu S. et al.Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration-resistant prostate cancer patients during abiraterone/enzalutamide treatment.Prostate. 2021; 81: 543-552Crossref PubMed Scopus (20) Google Scholar], stereotactic radiotherapy could be a therapeutic alternative to delay the new systemic line. We are pleased to see that our retrospective analyzes support this. We remain convinced that a prospective analysis with a larger number of patients would make it possible to highlight more specific prognostic factors, to better select SBRT candidates. We are excited to continue our work on this fascinating subject and to be able to exchange again. None.