Prostate Radiation Therapy or Short-Term Androgen Deprivation Therapy and Pelvic Lymph Node Radiation Therapy With or Without Prostate Radiation Therapy in Treating Patients With a Rising Prostate Specific Antigen (PSA) After Surgery for Prostate Cancer

Not Recruiting

Trial ID: NCT00567580


RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Androgens can cause the growth of prostate cancer cells. Antihormone therapy, such as flutamide, bicalutamide, and luteinizing hormone-releasing hormone agonist, may lessen the amount of androgens made by the body. It is not yet known which regimen of radiation therapy with or without androgen-deprivation therapy is more effective for prostate cancer. PURPOSE: This randomized phase III trial is studying prostate radiation therapy to see how well it works compared with short-term androgen deprivation therapy given together with pelvic lymph node radiation therapy with or without prostate radiation therapy in treating patients with a rising PSA after surgery for prostate cancer.

Official Title

A Phase III Trial of Short Term Androgen Deprivation With Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients With a Rising PSA After Radical Prostatectomy

Stanford Investigator(s)

Mark Buyyounouski, MD, MS, FASTRO
Mark Buyyounouski, MD, MS, FASTRO

Professor of Radiation Oncology (Radiation Therapy)


Inclusion Criteria:

   1. Adenocarcinoma of the prostate treated primarily with radical prostatectomy,
   pathologically proven to be lymph node negative by pelvic lymphadenectomy (N0) or
   lymph node status pathologically unknown (undissected pelvic lymph nodes [Nx]), i.e.
   lymph node dissection is not required;

   • Any type of radical prostatectomy will be permitted, including retropubic, perineal,
   laparoscopic or robotically assisted. There is no time limit for the date of radical

   2. A post-radical prostatectomy entry prostate-specific antigen (PSA) of ≥ 0.1 and < 2.0
   ng/mL at least 6 weeks (45 days) after prostatectomy and within 30 days of

   3. One of the following pathologic classifications:

      - T3N0/Nx disease with or without a positive prostatectomy surgical margin; or

      - T2N0/Nx disease with or without a positive prostatectomy surgical margin;

   4. Prostatectomy Gleason score of 9 or less;

   5. Zubrod Performance Status of 0-1;

   6. Age ≥ 18;

   7. No distant metastases, based upon the following minimum diagnostic workup:

      - History/physical examination (including digital rectal exam) within 8 weeks (60
      days) prior to registration;

      - A computerized tomography (CT) scan of the pelvis (with contrast if renal
      function is acceptable; a noncontrast CT is permitted if the patient is not a
      candidate for contrast) or magnetic resonance imaging (MRI) of the pelvis within
      120 days prior to registration;

      - Bone scan within 120 days prior to registration; if the bone scan is suspicious,
      a plain x-ray and/or MRI must be obtained to rule out metastasis.

   8. Adequate bone marrow function, within 90 days prior to registration, defined as

      - Platelets ≥ 100,000 cells/mm^3 based upon compete blood count (CBC);

      - Hemoglobin ≥ 10.0 g/dl based upon CBC (Note: The use of transfusion or other
      intervention to achieve Hgb ≥ 10.0 g/dl is recommended).

   9. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2 x the upper
   limit of normal within 90 days prior to registration;

10. Serum total testosterone must be ≥ 40% of the lower limit of normal (LLN) of the assay
   used (testosterone ÷ LLN must be ≥ 0.40) within 90 days prior to registration (Note:
   Patients who have had a unilateral orchiectomy are eligible as long as this
   requirement is met);

11. Patients must sign a study-specific informed consent prior to study entry.

Exclusion Criteria:

   1. A palpable prostatic fossa abnormality/mass suggestive of recurrence, unless shown by
   biopsy under ultrasound guidance not to contain cancer;

   2. N1 patients are ineligible, as are those with pelvic lymph node enlargement ≥ 1.5 cm
   in greatest dimension by CT scan or MRI of the pelvis, unless the enlarged lymph node
   is sampled and is negative;

   3. Androgen deprivation therapy started prior to prostatectomy for > 6 months (180 days)
   duration. Note: The use of finasteride or dutasteride (±tamsulosin) for longer periods
   prior to prostatectomy is acceptable;

   4. Androgen deprivation therapy started after prostatectomy and prior to registration
   (Note: The use of finasteride or dutasteride (±tamsulosin) after prostatectomy is not
   acceptable - must be stopped within 3 months after prostatectomy. Androgen deprivation
   therapy must be stopped within 3 months after prostatectomy);

   5. Neoadjuvant chemotherapy before or after prostatectomy;

   6. Prior chemotherapy for any other disease site if given within 5 years prior to

   7. Prior cryosurgery or brachytherapy of the prostate; prostatectomy should be the
   primary treatment and not a salvage procedure;

   8. Prior pelvic radiotherapy;

   9. Prior invasive malignancy (except non-melanomatous skin cancer) or superficial bladder
   cancer unless disease free for a minimum of 5 years [for example, carcinoma in situ of
   the oral cavity is permissible];

10. Severe, active co-morbidity, defined as follows:

      - History of inflammatory bowel disease;

      - History of hepatitis B or C; Blood tests are not required to determine if the
      patient has had hepatitis B or C, unless the patient reports a history of

      - Unstable angina and/or congestive heart failure requiring hospitalization within
      the last 6 months;

      - Transmural myocardial infarction within the last 6 months;

      - Acute bacterial or fungal infection requiring intravenous antibiotics at the time
      of registration;

      - Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness
      requiring hospitalization or precluding study therapy at the time of

      - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
      AST or ALT are required; note, however, that laboratory tests for coagulation
      parameters are not required for entry into this protocol.

      - Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers for Disease
      Control and Prevention (CDC) definition; Note, however, that human
      immunodeficiency viruses (HIV) testing is not required for entry into this
      protocol. The need to exclude patients with acquired immunodeficiency syndrome
      (AIDS) from this protocol is necessary because the treatments involved in this
      protocol may result in increased toxicity and immunosuppression.

11. Prior allergic reaction to the study drug(s) involved in this protocol.


radiation: PBRT

radiation: PLNRT

drug: AA

drug: LHRH agonist

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305

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