PEACE V: Salvage Treatment of OligoRecurrent Nodal Prostate Cancer Metastases

Prior treatment

• Previous irradiation of the pelvic and or para-aortic nodes
• Lymph node metastases in previously irradiated areas resulting in dose constraint violation
• 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 illness

• Contraindications to pelvic radiotherapy (chronic pelvic inflammatory bowel disease)
• 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.

Lab values

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

Other

• 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
• Symptomatic metastases

• 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.