Evaluation of the Change in PSMA Expression in Prostate Cancer in Response to Hormonal Therapy

NCT ID: NCT05919329

Last Updated: 2025-10-24

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

PHASE4

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-25

Study Completion Date

2030-09-01

Brief Summary

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This clinical trial investigates the change in prostate-specific membrane antigen (PSMA) expression in response to hormonal therapy in both, Castration Sensitive Prostate Cancer (CSPC) and Castration Resistant Prostate Cancer (CRPC), and whether this change in PSMA expression changes tumor staging after therapy initiation. Understanding these effects can help define the best timing to perform the PSMA positron emission tomography (PET) relative to the start of therapy.

Detailed Description

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PRIMARY OBJECTIVE:

I. To determine the early effects (at day 8) of hormonal therapy on PSMA modulation in patients with castration sensitive prostate cancer (CSPC) and castration resistant prostate cancer (CRPC)

SECONDARY OBJECTIVES:

I. To evaluate the effects of hormonal therapy on PSMA modulation at day 28 post-therapy in patients with CSPC and CRPC

II. To evaluate whether the change in PSMA modulation after hormonal therapy initiation changes the tumor staging on PSMA PET as defined by the PROMISE V2 criteria.

EXPLORATORY OBJECTIVES:

I. To assess whether the initial change in PSMA modulation in response to hormonal therapy holds prognostic implications

II. To assess for potential correlation between the early change in PSMA modulation and tumor characteristics such as Gleason score, and site of disease.

III. To assess whether the baseline level of PSMA uptake holds prognostic implications in response to hormonal therapy

OUTLINE:

Patients will be divided (non-randomized) into 2 groups (CRPC or CSPC) and receive PSMA PET prior to start of therapy (standard of care), then again 8 days and 28 days after initiation of hormonal therapy.

Participants will be followed for up to 5 years.

Conditions

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Castration Resistant Prostate Cancer Castration Sensitive Prostate Cancer Prostate Adenocarcinoma

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Cohort 1: CRPC

Patients with CRPC will receive 18F-DCFPyL PET prior to start of therapy (standard of care), then again 8 days and 28 days after initiation of hormonal therapy.

Group Type EXPERIMENTAL

Piflufolastat

Intervention Type DRUG

Given IV

PSMA PET/CT Scan

Intervention Type PROCEDURE

Undergo PSMA PET/CT

PSMA PET/MRI scan

Intervention Type PROCEDURE

Undergo PET/MRI

Biospecimen Collection

Intervention Type PROCEDURE

Undergo collection of blood samples

Electronic Health Record Review

Intervention Type OTHER

Ancillary studies

Cohort 2: CSPC

Patients with CSPC will receive 18F-DCFPyL PET prior to start of therapy (standard of care), then again 8 days and 28 days after initiation of hormonal therapy.

Group Type EXPERIMENTAL

Piflufolastat

Intervention Type DRUG

Given IV

PSMA PET/CT Scan

Intervention Type PROCEDURE

Undergo PSMA PET/CT

PSMA PET/MRI scan

Intervention Type PROCEDURE

Undergo PET/MRI

Biospecimen Collection

Intervention Type PROCEDURE

Undergo collection of blood samples

Electronic Health Record Review

Intervention Type OTHER

Ancillary studies

Interventions

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Piflufolastat

Given IV

Intervention Type DRUG

PSMA PET/CT Scan

Undergo PSMA PET/CT

Intervention Type PROCEDURE

PSMA PET/MRI scan

Undergo PET/MRI

Intervention Type PROCEDURE

Biospecimen Collection

Undergo collection of blood samples

Intervention Type PROCEDURE

Electronic Health Record Review

Ancillary studies

Intervention Type OTHER

Other Intervention Names

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Piflufolastat F-18 Pylarify 18F-DCFPyL Fluorine F 18 DCFPyL Prostate-Specific Membrane Antigen PET/CT PSMA PET/CT PSMA-Positron emission tomography/CT Prostate-Specific Membrane Antigen PET/MRI PSMA PET/MR PSMA-Positron emission tomography/magnetic resonance imaging Biological Sample Collection Specimen Collection Lab draw

Eligibility Criteria

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Inclusion Criteria

* Participant or legally authorized representative (LAR) must provide written informed consent before any study-specific procedures or interventions are performed.
* Participants must have confirmed prostate adenocarcinoma, histologically, or by combined imaging and biochemical markers.
* Age \>= 18 years. Given the nature of the disease in question, only men will be included. Members of all races and ethnic groups will be included.
* Participants must have sites of prostate cancer showing uptake on an initial PSMA PET scan.
* Participants are planned to receive hormonal therapy within eight weeks of the initial PSMA PET. The hormonal therapy agents include:

* For CSPC: GnRH agonists, GnRH antagonists, first-generation antiandrogen (e.g. bicalutamide), or androgen receptor (AR)-targeted agent (e.g. Abiraterone, Enzalutamide, Apalutamide, Darolutamide)
* For CRPC: this group of patients are typically on continuous ADT (GnRH agonists or antagonists), which will be continued, and the hormonal therapy they will be started on is an androgen receptor (AR)-targeted agent (e.g. Abiraterone, Enzalutamide, Apalutamide, Darolutamide)
* Life expectancy \> 3 months.
* Cohort 1: Castration resistant prostate cancer with rising PSA (confirmed by two PSA values at least 1 week apart), testosterone \< 50 ng/dL, on continuous ADT at least 4 months, no AR targeted agent in the prior 4 months.
* Cohort 2: Castration sensitive prostate cancer with no ADT or AR targeted agents use in the past 12 months, testosterone \>50 ng/dL

Exclusion Criteria

* Uncontrolled serious infection.
* Intercurrent illness or condition that would limit compliance with study requirements.
* Participants who have undergone any cancer treatment other than the hormonal therapy (systemic or radiation therapy) or who have started any supplements or herbal medications intended to treat cancer between the baseline PSMA PET and PSMA PET at day 28.
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Oregon Health and Science University

OTHER

Sponsor Role collaborator

Progenics Pharmaceuticals, Inc.

INDUSTRY

Sponsor Role collaborator

OHSU Knight Cancer Institute

OTHER

Sponsor Role lead

Responsible Party

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Nadine Mallak, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nadine Mallak, MD

Role: PRINCIPAL_INVESTIGATOR

OHSU Knight Cancer Institute

Locations

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OHSU Knight Cancer Institute

Portland, Oregon, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Lauren Drake

Role: CONTACT

503-494-4960

Facility Contacts

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Lauren Drake

Role: primary

503-494-4960

Other Identifiers

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NCI-2023-06184

Identifier Type: REGISTRY

Identifier Source: secondary_id

STUDY00025799

Identifier Type: -

Identifier Source: org_study_id

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