ctDNA positivity before SBRT predicts rapid progression in oligoprogressive CRPC
Retrospective · JAMA Netw Open · 2026-11-12. Number 2 in the UrologyWatch Top 5 for November 12, 2026.
In this prespecified secondary analysis of the phase 2 TRAP trial, 19 of 77 evaluable patients (24.7%) were ctDNA-positive before SBRT; their 6-month progression-free survival was 21.1% versus 58.3% for ctDNA-negative patients, with median PFS of 3.0 versus 7.8 months (P = .003). Median overall survival was 27.2 months for ctDNA-positive patients and 33.6 months for ctDNA-negative patients.
Why it matters: Baseline ctDNA status may help identify oligoprogressive CRPC patients less likely to benefit from SBRT, supporting its potential use in selecting candidates for metastasis-directed therapy versus earlier systemic change.
Limitation: This is a secondary analysis of a nonrandomized single-arm trial with a small ctDNA-positive subgroup (n=19) and overall survival differences that were not formally tested for statistical significance.
Source: JAMA Netw Open · PubMed 43013307 · DOI 10.1001/jamanetworkopen.2026.43400
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