PSMA-Directed Para-Aortic Radiation Therapy for Oligorecurrent Prostate Cancer

Prior treatment

• History of prior radiation therapy outside the pelvis for prostate cancer
• Androgen deprivation therapy (ADT) or chemotherapy in the three months prior to staging PSMA PET/CT scan (suggesting oligoprogressive disease, rather than true oligorecurrent disease) or at time of study enrollment

Other illness

• Patient has more than 5 sites of metastatic disease
• Patient has history of bone and/or visceral metastasis
• No evidence of disease in the para-aortic or pelvic lymph nodes
• Bulky nodal disease \>5 cm in tumor size
• Suspicious radiologic evidence of disease in the prostate on staging PSMA PET/CT scan without confirmatory negative prostate biopsy
• History of inflammatory bowel disease
• History of malignancy other than prostate cancer except for non-melanoma skin cancer

Lab values

• Castration-resistant prostate cancer (history of rising PSA with serum testosterone level \<50 ng/dL)

Other

• No pathological diagnosis of prostate adenocarcinoma
• No staging with PSMA PET/CT scan
• Implanted hardware which limits treatment planning or delivery (determined by treating physician)
• Patients with ECOG performance status \> 2
• Patients unable to consent or are prisoners
• Unwilling to fill out quality of life and psychosocial forms
• Participants with impaired decision-making capacity

• Histologically proven prostate adenocarcinoma
• Male, ≥ 18 years old
• Oligorecurrent disease limited to the sub-diaphragmatic region with or without pelvic lymph nodes
  • a. No more than a total of 5 lesions on PSMA PET/CT scan (each lesion defined as positive with standardized uptake value (SUV) \> liver uptake and CT scan correlate)
  • b. No disease outside of the pelvic and sub-diaphragmatic para-aortic lymph nodes
  • c. At least one lesion in the sub-diaphragmatic pelvic or para-aortic lymph nodes
  • d. Non-bulky nodal disease (ie, tumor \<5 cm)
• Prior pelvic radiation with disease response
  • a. Definitive radiation therapy to the prostate with or without treatment of the pelvic lymph nodes and/or
  • b. Salvage or adjuvant radiation therapy to the prostate bed following prostatectomy with or without treatment of the pelvic lymph nodes
• Hormone-sensitive prostate cancer
• Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2
• Ability to understand the investigational nature, potential risks and benefits of the research study, and willingness to sign the written informed consent and HIPAA document(s)
• Willingness to fill out quality of life and psychosocial forms
• Willingness to participate in our institution's Prostate Cancer Database Protocol (ID# 20090767)