Systemic and tumor-directed therapy for oligometastatic prostate cancer: study protocol for a phase II trial for veterans with de novo oligometastatic disease

BACKGROUND

The treatment paradigm for metastatic hormone-sensitive prostate cancer (mHSPC) patients is evolving. PET/CT now offers improved sensitivity and accuracy in staging. Recent randomized trial data supports escalated hormone therapy, local primary tumor therapy, and metastasis-directed therapy. The impact of combining such therapies into a multimodal approach is unknown. This Phase II single-arm clinical trial sponsored and funded by Veterans Affairs combines local, metastasis-directed, and systemic therapies to durably render patients free of detectable disease off active therapy.

METHODS

Patients with newly-diagnosed M1a/b prostate cancer (PSMA PET/CT staging is permitted) and 1-5 radiographically visible metastases (excluding pelvic lymph nodes) are undergoing local treatment with radical prostatectomy, limited duration systemic therapy for a total of six months (leuprolide, abiraterone acetate with prednisone, and apalutamide), metastasis-directed stereotactic body radiotherapy (SBRT), and post-operative fractionated radiotherapy if pT ≥ 3a, N1, or positive margins are present. The primary endpoint is the percent of patients achieving a serum PSA of < 0.05 ng/mL six months after recovery of serum testosterone ≥150 ng/dL. Secondary endpoints include time to biochemical progression, time to radiographic progression, time to initiation of alternative antineoplastic therapy, prostate cancer specific survival, health related quality-of-life, safety and tolerability.

DISCUSSION

To our knowledge, this is the first trial that tests a comprehensive systemic and tumor directed therapeutic strategy for patients with newly diagnosed oligometastatic prostate cancer. This trial, and others like it, represent the critical first step towards curative intent therapy for a patient population where palliation has been the norm.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03298087 (registration date: September 29, 2017).

A preliminary outcome study of a community group treatment programme for emotionally disturbed adolescents

The treatment of adolescents with psychiatric disturbance remains a highly unsuccessful area. Empirical research is limited and treatment decisions are often based on theoretical bias rather than proven results. This study reports on the results of a multivariate analysis of pre- and post-individual and family measures on patients in a community based day and evening programme. The programme utilized a broad range of treatment modalities including group and family therapy and chemotherapy. An accredited educational programme was also provided to the patients attending the day programme. The results of this study showed that adolescents were referred to either the day or evening programme components based on level of acting out behaviour rather than on DSM III diagnosis. Adolescents reported significant positive changes at post testing in all areas, but this improvement was not endorsed by parents. Although therapists perceived considerable improvement in their families after treatment, this improvement did not show up on the family assessment measure chosen. The findings of the study endorse the need for further empirical research in adolescent treatment and underscores the fallacy of relying on anecdotal evidence to report treatment results. Questions are raised as to the operational usefulness of the present DSM III criteria in making treatment decisions and the validity of associating individual dysfunction with family dysfunction. Some question as to the sensitivity of the family measure used was also raised. The study outlined strengths and weaknesses in the present treatment programme and underscored the importance of further evaluative research, if the treatment of adolescents with psychiatric disturbance is to become successful.