PSMA PET-Staged Comprehensive Progression-Directed Radiotherapy for Limited Progression in Prostate Cancer

* Age 18 years or older. * Histologically confirmed prostate adenocarcinoma. * Metastatic hormone-sensitive or metastatic castration-resistant prostate cancer. * Active systemic anticancer therapy at the qualifying limited-progression assessment. * Qualifying baseline PSMA PET/CT or PSMA PET/MRI with review of relevant anatomical imaging. * Metachronous, repeat, or induced oligoprogression or limited progression according to the protocol framework. * Retrospective cases treated before June 26, 2026: 1-5 qualifying progressing metastatic lesions. * Prospective cases enrolled before the site-specific amendment effective date: 1-5 qualifying progressing metastatic lesions. * Prospective cases enrolled after the site-specific amendment effective date: 1-10 qualifying progressing metastatic lesions, prespecified as 1-5 or 6-10. * Intraprostatic or prostate-bed progressing foci are recorded separately from the metastatic-lesion count and must also be technically amenable to comprehensive PDRT. * Every qualifying metastatic and local progressing site is judged technically amenable to comprehensive definitive-intent PDRT before prospective analytic-cohort enrollment. * For post-amendment prospective enrollment, qualifying PSMA PET performed within 60 days before enrollment and index PDRT planned to begin within 60 days after the scan. * Availability of the qualifying PET date, systemic-therapy dates, locked metastatic-lesion count, separate local-site count, lesion map, and eligibility decision. For retrospective inclusion, PDRT exposure and at least one outcome or censoring time must also be determinable. Exclusion Criteria * Limited progression defined only by conventional CT, MRI, or bone scintigraphy without a qualifying PSMA PET examination. * More than five qualifying progressing metastatic lesions for retrospective or pre-amendment inclusion. * More than 10 qualifying progressing metastatic lesions after amendment activation. * Diffuse, non-enumerable, or rapidly progressive disease that is not considered suitable for comprehensive lesion-directed radiotherapy. * Any known active metastatic or local progressing site that cannot be included in the comprehensive PDRT plan. * Clinical deterioration or an urgent systemic-treatment indication that makes comprehensive PDRT inappropriate or unsafe. * Radiotherapy delivered solely with palliative symptom-control intent rather than definitive progression-directed local-control intent. * For prospective participation, inability to complete the approved consent process. * For retrospective cases, missing baseline imaging or core dates such that metastatic burden, PDRT exposure, or at least one outcome or censoring time cannot be determined reliably.