PEACE V : Etude randomisée de phase II pour le traitement de rattrapage du cancer de la prostate en récidive ganglionnaire oligométastatique (STORM)

Radiation: whole pelvic radiotherapy;Radiation: metastasis-directed treatment;Procedure: salvage Lymph Node Dissection;Drug: androgen deprivation therapy

Gender: Male
Maximum age: N/A
Minimum age: 18 Years
Inclusion Criteria:

- Histologically proven initial diagnosis of adenocarcinoma of the prostate

- Biochemical relapse of prostate cancer following radical local prostate treatment
(radical prostatectomy, primary radiotherapy or radical prostatectomy +/- prostate
bed adjuvant/ salvage radiotherapy) according to the EAU guidelines 2016.

- Following radical prostatectomy, patients with a biochemical relapse are eligible in
case a nodal relapse is detected in the pelvis even in the absence of prior
postoperative prostate bed radiotherapy (adjuvant or salvage).

- In case of a suspected local recurrence following primary radiotherapy, a biopsy
should confirm local recurrence and patients with a confirmed local recurrence are
eligible in case they also undergo a local salvage therapy. If imaging rules out
local relapse, patients are eligible.

- Nodal relapse in the pelvis on choline, PSMA or FACBC PET-CT with a maximum of 3
positive nodal lymph nodes. The upper limit of the pelvis is defined as the aortic
bifurcation.

- WHO performance state 0-1

- Age >18 years

- Absence of any psychological, familial, sociological or geographical condition
potentially hampering compliance with the study protocol and follow-up schedule;
those conditions should be discussed with the patient before registration in the
trial

- Before patient registration/randomization, written informed consent must be given
according to ICH/GCP, and national/local regulations.

Exclusion Criteria:

- Bone or visceral metastases

- Para-aortic lymph node metastases (above the aortic bifurcation)

- Local relapse in the prostate gland or prostate bed not suitable for a curative
treatment

- Previous irradiation of the pelvic and or para-aortic nodes

- Serum testosterone level <50ng/dl or 1.7 nmol/L at time of randomization

- Symptomatic metastases

- Lymph node metastases in previously irradiated areas resulting in dose constraint
violation

- Contraindications to pelvic radiotherapy (chronic pelvic inflammatory bowel disease)

- Contraindications to androgen deprivation therapy

- PSA rise while on active treatment with (LHRH-agonist, LHRH-antagonist,
anti-androgen, estrogen

- Previous treatment with cytotoxic agent for PCa

- Treatment during the past month with products known to influence PSA levels (e.g.
fluconazole, finasteride, corticosteroids,...)

- Other active malignancy, except non-melanoma skin cancer or other malignancies with
a documented disease-free survival for a minimum of 3 years before randomization.