Background: For patients with metastatic cancer, a key aspect of interdisciplinary care has involved the overall prognosis provided by Medical Oncology, which often dictates the intensity and direction of further care while impacting all other disciplines, most prominently Radiation Oncology, Surgical Oncology and Palliative Medicine. Despite the millions of patients for whom such prognoses have been ascribed, the success rate of Medical Oncology prognosis has been sparsely described. This study represents prospective evaluation of Medical Oncology prognosis accuracy for patients having been considered for enrollment onto an ongoing Phase 2 randomized controlled oncology trial. Methods: The ongoing Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) clinical trial (clinicaltrials.gov number NCT05617716) is a Phase 2 randomized clinical trial examining optimal radiation therapy treatment of symptomatic spinal metastases with a primary endpoint of pain freedom at 3 months post-treatment. A key eligibility criteria for trial enrollment is overall prognosis exceeding 3 months, typically provided by Medical Oncology. During the first year of trial enrollment, Medical Oncology prognosis for patients considered for SPORTSMEN inclusion was prospectively assessed for accuracy. Results: From January 2023 through December 2023, a total of 27 patients with documented Medical Oncology prognosis were considered for SPORTSMEN enrollment. Medical Oncology administered a prognosis exceeding three months in 26 patients, and less than three months in one patient. Of patients with a prognosis exceeding three months, 12 (46%) succumbed to death or hospice care prior to three months; the patient ascribed a prognosis of less than three months did not survive to exceed this threshold. The Medical Oncology prognosis overall was proven correct for 15 of 27 patients (56%). Medical Oncologist prognostic accuracy was 13/19 (68.4%) for outpatients, and 2/8 (25%) for inpatients; this difference was statistically significant (p=0.0381). Conclusions: In patients with symptomatic metastatic spine disease, the estimated prognosis provided by Medical Oncology is often optimistic, as nearly half of patients assigned a prognosis of greater than three months failed to reach this threshold before experiencing death or hospice. These findings indicate that providers considering enrolling patients on clinical trials should expect a prognosis overestimation rate exceeding 40%. Consequently, a more heuristic approach to assessing patient prognosis may be necessary to avoid unwarranted prognostic optimism, particularly for inpatients. Such an approach could potentially provide a more compassionate and cost-effective management of these patients’ remaining lifespan thereby optimizing quality-of-life.