The MetaCURE trial tested an intensive multimodal approach combining apalutamide-based hormone therapy, surgical resection, and targeted radiation in 65 men with newly diagnosed high-risk prostate cancer. After 10 months of treatment followed by radical prostatectomy, 61% of localized disease patients and 39% of metastatic patients maintained undetectable PSA levels at 24 months with recovered testosterone levels above 150 ng/dL. This represents a significant advancement in treatment-naive prostate cancer management, where traditional approaches often require lifelong hormone suppression with substantial quality-of-life impacts. The protocol's ability to achieve durable remission while allowing testosterone recovery addresses a critical gap in oncology care. However, the 12-15% complete pathologic response rates suggest room for improvement in drug combinations. The study's strength lies in demonstrating feasibility of aggressive upfront treatment in oligometastatic disease, historically considered incurable. The framework could accelerate testing of novel agents by providing rapid efficacy readouts within 24 months rather than the typical 5-10 year survival endpoints. While promising, longer follow-up is essential to confirm whether these early biochemical responses translate to improved overall survival, and whether the intensive approach justifies its toxicity burden compared to standard sequential therapies.