5500/20 vs. SABR or Brachytherapy for PRimary OligoMetastatic Prostate Cancer Treatment (PROMPT)

NCT ID: NCT04610372

Last Updated: 2026-02-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

168 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-07-12

Study Completion Date

2033-06-30

Brief Summary

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We will investigate whether ultrahypofractionation using stereotactic ablative radiotherapy (SABR) or brachytherapy is as well-tolerated as moderately hypofractionated external beam radiotherapy (EBRT) for treating the prostate in patients with oligometastatic prostate cancer. Secondary aims include assessment of progression-free survival (PFS) and overall survival (OS) as well as cost-effectiveness. We hypothesize that ultrahypofractionation will maintain favorable toxicity profiles and quality of life while achieving comparable or better efficacy, thereby providing a convenient and cost-effective alternative to moderately hypofractionated EBRT.

Detailed Description

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Men newly diagnosed with low volume oligometastatic prostate cancer defined as fewer than 5 bone metastases and/or non regional lymph node involvement who agree to treatment of the primary cancer with radiation will be randomized between standard moderately hypofractionated external radiotherapy (5500 centiGray/20 fractions as per Stampede trial) and one of 3 alternatives: stereotactic body radiotherapy (SABR) to deliver 36 Gy/5 fractions, or low dose rate Iodine 125 permanent seed implant or a single high dose rate temporary implant. The trial will take place in 4 regional cancer centers of British Columbia Cancer Agency, with each center choosing their preferred alternative to 5500/20. To achieve 4 equally sized treatment arms, each randomization is weighted 3:1 for 42 patients in each arm and 168 total accrual. The primary endpoint is urinary quality of life as assessed by the International Prostate Symptom Score (IPSS) . As the typical acute symptoms from each of these radiation modalities has a unique time course, assessments are done at 6 different points during the first 2 years. Secondary endpoints are global quality of life as assessed by Expanded Prostate Cancer Index (EPIC) urinary, bowel and sexual scores, progression free survival, overall survival and cost effectiveness.

Conditions

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Oligometastatic Prostate Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

There is one standard arm (5500/20) and 3 alternative arms. The alternative arms are selected at the treating center. Thus, each randomization is 2-way, but with a 3:1 weighting so that the 4 treatment arms have equal numbers of patients.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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standard

External beam radiotherapy to deliver 5500 centiGray (cGy) in 20 fractions to the prostate over 4 weeks

Group Type ACTIVE_COMPARATOR

Hypofractionated external beam radiotherapy

Intervention Type RADIATION

5500 cGy/20 fractions delivered 5 days per week over 4 weeks

High dose rate brachytherapy

A single fraction of 19 Gray (Gy) is delivered to the prostate under anesthesia as an out patient.

Group Type EXPERIMENTAL

High dose rate brachytherapy

Intervention Type RADIATION

A single fraction of 19 Gy is delivered from an automated afterloading Iridium-192 source via interstitial catheters placed under ultrasound guidance

Permanent seed implant brachytherapy

A single permanent implant of radioactive Iodine-125 seeds is performed under anesthesia as an out patient to deliver 125 Gy to the prostate

Group Type EXPERIMENTAL

Permanent seed implant

Intervention Type RADIATION

Iodine-125 radioactive seeds are implanted permanently in the prostate in a single procedure under transrectal ultrasound guidance

Stereotactic body radiotherapy

36.25 Gy is delivered to the prostate in 5 fractions given either weekly or every second day, using a SABR technique.

Group Type EXPERIMENTAL

Stereotactic body radiotherapy

Intervention Type RADIATION

External radiation using SABR technology delivers 36.25 Gy to the prostate in 5 fractions given either once weekly for 5 weeks or every second day over 2 weeks.

Interventions

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Hypofractionated external beam radiotherapy

5500 cGy/20 fractions delivered 5 days per week over 4 weeks

Intervention Type RADIATION

High dose rate brachytherapy

A single fraction of 19 Gy is delivered from an automated afterloading Iridium-192 source via interstitial catheters placed under ultrasound guidance

Intervention Type RADIATION

Permanent seed implant

Iodine-125 radioactive seeds are implanted permanently in the prostate in a single procedure under transrectal ultrasound guidance

Intervention Type RADIATION

Stereotactic body radiotherapy

External radiation using SABR technology delivers 36.25 Gy to the prostate in 5 fractions given either once weekly for 5 weeks or every second day over 2 weeks.

Intervention Type RADIATION

Other Intervention Names

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Low dose rate brachytherapy SABR

Eligibility Criteria

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Inclusion Criteria

* Able to provide informed consent
* European Cooperative Oncology Group performance status 0 to 2
* Medically fit for all protocol treatment and follow-up
* Histologically confirmed adenocarcinoma of the prostate
* Newly diagnosed any Tumor stage, any Nodal stage but with oligo metastases
* No prior therapy for prostate cancer apart from androgen deprivation
* Able to complete the necessary investigations prior to randomization (History and physical examination, PSA)
* Able to complete the necessary investigations prior to start of Radiotherapy (Transrectal ultrasound-guided biopsy or equivalent, CT chest, abdomen \& pelvis or MRI abdomen and pelvis, and Bone scan)
* Planned for long-term androgen deprivation therapy (greater than 9 months in duration)
* Patient is able and willing to complete the quality of life questionnaires, and other assessments that are a part of this study

Exclusion Criteria

* High metastatic burden defined as 5 or more bone metastases or visceral metastases
* Abnormal liver function
* Contraindications to EBRT such as active inflammatory bowel disease or previous pelvic radiation

Contraindications to brachytherapy including:

* Medically unfit for anesthesia,
* International Prostate Symptom Score (IPSS) greater than 20
* Poor urinary flow with peak flow rate less than10 mL per second or post-void residual greater than 25 per cent of voided volume (when uroflowmetry available)
* Prostate volume greater than 60cc after maximal cytoreduction
* Pubic arch interference
* Transurethral resection of prostate (TURP) within 12 weeks of brachytherapy
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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British Columbia Cancer Agency

OTHER

Sponsor Role lead

Responsible Party

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Juanita Crook

Professor of Radiation Oncology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Juanita Crook, MD

Role: PRINCIPAL_INVESTIGATOR

BCCancer

Locations

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British Columbia Cancer Agency Center for the Southern Interior

Kelowna, British Columbia, Canada

Site Status RECRUITING

Fraser Valley Cancer Center

Surrey, British Columbia, Canada

Site Status NOT_YET_RECRUITING

Vancouver Cancer Center

Vancouver, British Columbia, Canada

Site Status RECRUITING

Vancouver Island Cancer Center

Victoria, British Columbia, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Juanita Crook, MD

Role: CONTACT

250 712 3958

Facility Contacts

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Juanita Crook, MD

Role: primary

250 712 3958

Winkle Kwan, MD

Role: primary

Mira Keyes, MD

Role: primary

604-266-6444

Saibishkumar Elantholi Parmeswaran, MD

Role: primary

Other Identifiers

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H20-01207

Identifier Type: -

Identifier Source: org_study_id

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