Testing Treatment for Prostate Cancer

Eligibility Details: Inclusion Criteria: - Histologic diagnosis/confirmation of prostate adenocarcinoma and no evidence of small cell cancer. - Stage IV at presentation or relapse after curative intent therapy, classification per AJCC 8th edition: M1 disease with ≤ 5 metastases - ≤ 3 metastases in any non-bone organ system - Zoladex must commence within 12 weeks prior to randomization or within 6 weeks after randomization. - Radiology (CT/MRI chest/abdomen/pelvis) within 28 days of randomization - Bone scan within 28 days of randomization - All tumours (Primary prostate and metastases) must be amenable to local ablative therapy (SBRT and/or surgery). - Age ≥ 18 - ECOG performance 0-1 - Patient is able (i.e. sufficiently fluent) and willing to complete the quality of life and economics questionnaires in either English or French - Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements. Each patient must sign a consent form prior to enrollment in the trial to document their willingness to participate - Patients must be medically suitable for study treatments as assessed by the appropriate specialties: medical, radiation, and surgical - Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen - Patients must be accessible for treatment and follow-up. Investigators must assure themselves the patients randomized on this trial will be available for complete documentation of the treatment, adverse events, and follow-up - In accordance with CCTG policy, ablative therapy to metastases is to begin within 6 weeks after patient randomization - Men of childbearing potential must have agreed to use a highly effective contraceptive method to prevent pregnancy while on study - Patient must consent to provision of, and Investigator must confirm access to and agree to submit tumour tissue and whole blood for cfDNA. Exclusion Criteria: - Prior treatment with ADT in the neoadjuvant or adjuvant setting, unless treatment was discontinued ≥ 12 prior to randomization AND total duration of treatment was ≤ 36 months (including expiry of last depot injection). - Previously diagnosed recurrent/metastatic disease which has been already treated with any systemic therapy or radiotherapy - Castration resistant prostate cancer, defined as rising PSA or radiographic progression in the setting of castrate levels of serum testosterone (< 1.7 nmol/L). - Patients with previously untreated pelvic lymph nodes (N1), as the only site of disease at enrollment. - Inability to treat all sites of disease with local ablative therapy - Patients with parenchymal brain metastases