Prostate Cancer
Conditions
Brief summary
This study is evaluating whether adding stereotactic radiotherapy (a new, more focused type of radiotherapy) to treat all the tumours that are present will improve outcomes or not compared to drugs alone for patients who are negative on conventional imaging and positive on PSMA PET scan
Interventions
RADIATIONSBRT
SBRT to all sites of metastatic disease as seen on PSMA PET scan
DRUGHormone therapy
Intermittent Hormone Therapy per physician discretion (Min. 8 months)
Sponsors
Sunnybrook Health Sciences Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age \> 18 years. 2. Able to provide informed consent. 3. Histologic diagnosis of prostate adenocarcinoma. 4. ECOG performance status 0-1. 5. Stage IV hormone sensitive, synchronous or metachronous oligometastatic prostate cancer as detected by PSMA PET-CT scan with no metastases visible on conventional imaging (CT chest/abdomen/pelvis and bone scan +/- MRI) performed within 3 months of starting ADT. 6. Up to a maximum of 3 PSMA avid areas of metastatic disease. 7. For patients with metachronous disease, there must be a documented PSA rise. For those who had previous prostatectomy, PSA must be \> 0.2 ng/mL. For those who had previous radical radiotherapy, PSA must have risen to at least 2 ng/mL above the nadir (Phoenix definition). The primary tumor must be controlled, with no PSMA avid progression within the primary prostate. 8. All sites of disease are amenable to and can be safely treated with SBRT.
Exclusion criteria
1. Significant comorbidities rendering patient not suitable for ADT and/or SBRT. 2. History of malignancy within the past 5 years, excluding non-melanoma skin cancer and in-situ cancer. 3. Prior use of salvage or palliative intent ADT. Prior ADT use allowed only if it was delivered neoadjuvantly, concurrently, or adjuvantly with curative-intent treatment to the prostate or prostate bed (for patients with metachronous presentations), and at least 12 months have elapsed. 4. Castrate resistant prostate cancer. 5. Evidence of spinal cord compression.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of eligible patients who enroll onto the study | Through accrual completion, approx 2 years | The primary purpose of this feasibility study is to measure the proportion of patients who are willing to enter this randomized trial |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Side Effects and Effectiveness | Through study completion, approx 5 years | An important secondary purpose is to measure the side effects and effectiveness of adding stereotactic radiotherapy to all sites of disease to intermittent hormone therapy compared to intermittent hormone therapy alone, using CTCAE v.5 |
Countries
Canada
Outcome results
None listed