How to cite: Deville C. Role of Radiation in Metastatic Prostate Cancer: Primary and Metastatic Sites. Grand Rounds in Urology. October 2025. Accessed Oct 2026. https://grandroundsinurology.com/role-of-radiation-in-metastatic-prostate-cancer-primary-and-metastatic-sites/
Summary
Curtiland Deville, Jr., MD, FASTRO, FACR, Associate Professor of Radiation Oncology and Molecular Radiation Sciences, Clinical Director, JH Sibley Radiation Oncology, Medical Director, JH Proton Therapy Center, Co-Director, JH Sibley Prostate Cancer Multidisciplinary Clinic, Johns Hopkins, Washington, DC, describes how radiation therapy functions across the continuum of metastatic prostate cancer. He shows how patterns of spread influence treatment goals, explaining that limited metastatic burden may support meaningful and durable control with targeted therapy. He uses diagrams that progress from localized disease to oligometastatic and polymetastatic states to show how the likelihood of cure decreases and that disease containment becomes a primary goal.
Dr. Deville reviews evidence for radiation to the primary tumor in men with low-volume metastatic disease, focusing on data indicating how prostate-directed therapy may improve outcomes in this group. He then reviews dose approaches, highlighting how modern delivery techniques allow for effective treatment with minimal toxicity.
Dr. Deville then addresses metastasis-directed therapy, specifically how stereotactic radiation supports high-precision treatment of limited metastatic lesions in oligometastatic disease. He reviews the limited clinical findings from studies and presents imaging examples of lesion targeting and local response following therapy.
He discusses patient selection, emphasizing the importance of disease volume, imaging findings, prior therapy, and fitness. He concludes by reinforcing that when applied to the correct clinical scenarios, radiation remains an important tool that supports control of metastatic prostate cancer.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation, and state-of-the-art BPH management with novel technologies.
ABOUT THE AUTHOR
Curtiland Deville, Jr., MD, FASTRO, FACR, is an Associate Professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins in Washington, DC. Dr. Deville also serves as the Medical Director of the Johns Hopkins Proton Therapy Center, Clinical Director of Radiation Oncology at Sibley Memorial Hospital, and Co-Director of the Kimmel Cancer Center Prostate Multidisciplinary Clinic at Sibley Memorial Hospital in Washington, DC. He is an expert in proton therapy and a leader in several institutional and national clinical trials. Dr. Deville’s clinical interests include genitourinary malignancies, including prostate cancer, and soft tissue sarcomas.
