This multi-center randomized controlled phase II trial was carried out in several hospitals in China to evaluate the efficacy and safety of radiotherapy or radical prostatectomy combined with intense androgen deprivation therapy for newly diagnosed metastatic prostate cancer.
Histologically or cytologically confirmed prostate adenocarcinoma, with distant metastasis diagnosed by novel imaging modalities (PSMA PET/CT or PSMA PET/MR), involving ≤10 metastatic sites (amenable to local therapy) and without visceral metastasis.
The primary lesion is deemed resectable, or can achieve a resectable state following IADT.
Non-castration range (≥50 ng/dl), or the duration of testosterone levels in the castration range is no more than 3 months.
Eastern Cooperative Oncology Group (ECOG) physical condition score ≤ 1.
Patients with prostatic histopathology exhibiting neuroendocrine, small cell, or sarcomatoid features.
The researchers assessed the primary lesion as unresectable.
Patients who had previously received androgen deprivation therapy (including medical or surgical castration) for more than 3 months, or had undergone focal therapy for prostate cancer, or had received radiotherapy or chemotherapy for prostate cancer.
Patients with severe or uncontrolled underlying diseases who could not tolerate surgery or radiotherapy.
Parallel
Intense androgen deprivation therapy
DrugPatients received ADT plus second-generation ARi (enzalutamide, apalutamide, darolutamide or rezvilutamide) for 2 years.
Radiation Therapy
RadiationThose allocated radiotherapy received 70Gy/2.8Gy/25f schedule for primary tumor and 70Gy/2.6-2.8Gy/25f or 37.5Gy/7.5Gy/5f for metastatic lymph nodes and bone lesions based on the size and location. Radiation should be finished within 2 years' systemic therapy.
radical prostatectomy
Procedure/SurgeryThose allocated surgery received robot-assisted laparoscopic radical prostaectomy plus extended pelvic lymph node dissection for local treatment. Surgery should be finished within 2 years' systemic therapy.
Event-free Survival
Following 2 years of treatment, any anti-tumor treatment was terminated for those who met complete remission until two consecutively rised PSA\>0.2ng/ml. Complete remission is interpreted as PSA level\<0.1ng/ml and absence of radiographic as well as clinical progression following the 2-year treatment, both are indispensable. The primary outcome was event-free survival (EFS), defined as the time from disease complete remission to any required anti-tumor treatment.
progression-free survival
Defined as from treatment initiation to PSA progression or radiographic/clinical progression. PSA progression is defined as PSA \>1 ng/ml, with two consecutive PSA measurements at least one week apart showing a 50% or greater increase from baseline). Radiographic progression is defined as development of two or more new bone metastases or progression of soft tissue lesions according to RECIST 1.1 criteria. Clinical progression is defined as worsening clinical symptoms and signs as determined by the physician.
Time to CRPC
Time to CRPC (castration-resistant prostate cancer (CRPC) is calculated from treatment initiation to the development of CRPC. CRPC is defined as serum testosterone at castration level (\<50 ng/dl or 1.7 nmol/l), while meeting one of the following criteria: a. Biochemical progression: Three consecutive PSA rises, each measured at least one week apart, with at least two increases exceeding 50% above baseline, and at least one PSA value \>2 ng/ml. b. Radiographic progression: Development of two or more new bone metastases, or progression of soft tissue lesions according to RECIST criteria.
Adverse events
valuate all adverse events (AEs) and grade them according to NCI-CTCAE v5.0.
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The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
Lead sponsor
The First Affiliated Hospital of Soochow University
Collaborator
Peking University First Hospital
Collaborator
