Stereotactic Body Radiation Therapy Without Androgen Deprivation in a 92-Year-Old With Oligometastatic Stage IVA Prostate Cancer: A Case Report

We report a case of a 92-year-old elderly male with Stage IVA oligometastatic prostate adenocarcinoma to the pelvic nodes managed successfully with stereotactic body radiotherapy (SBRT) alone. The patient declined androgen deprivation therapy (ADT) with concerns about quality of life and reported side effects. He was treated with weekly SBRT targeting the prostate and pelvic lymph nodes without a rectal spacer, experiencing only Grade 1 urinary toxicity. The prostate-specific antigen (PSA) significantly declined from 12.05 to 0.16 ng/ml at the six-month follow-up. This case shows the feasibility and tolerability of SBRT as monotherapy in select elderly patients with regional risk node-positive prostate cancer.