TERPS Trial for de Novo Oligometastic Prostate Cancer

Inclusion Criteria:

1. Patient must have at least one and up to three asymptomatic metastatic tumor(s) ofthe 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 advancedfunctional imaging such as fluciclovine (Axumin), choline or PSMA PET-CT scan.

2. CT or MRI scan within 6 months of enrollment

3. Bone scan within 6 months of enrollment

4. Fluciclovine (Axumin), choline, or PSMA PET-CT scan within 6 months ofenrollment (PET-CT scan is reasonable for study entry imaging as an alternativeto CT/MRI scan and bone scan)

5. Histologic confirmation of malignancy (primary or metastatic tumor).

6. Patient may have had prior systemic therapy and/or ADT associated with treatmentwithin 9-months of enrollment.

7. PSA > 0.5 but <100.

8. Patient must be ≥ 18 years of age.

9. Patient must have a life expectancy ≥ 12 months.

10. Patient must have an ECOG performance status ≤ 2.

11. Patient must have the ability to understand and the willingness to sign a writteninformed consent document

Exclusion Criteria:

1. Castration-resistant prostate cancer (CRPC).

2. Prior radiation therapy to an overlapping site of a target lesion that wouldpreclude further radiation therapy

3. Spinal cord compression or impending spinal cord compression.

4. Suspected pulmonary and/or liver metastases (greater >10 mm in largest axis).

5. Patient receiving any other investigational agents.

6. Inability to receive any form of systemic therapy in the opinion of a treatingmedical oncologist .

7. Unable to lie flat during or tolerate PET/MRI, PET/CT or SABR.

8. No radiographical evidence of cranial metastasis.

9. Refusal to sign informed consent.