A Phase II Trial of Samarium 153 Followed by Salvage Prostatic Fossa 3D-CRT or IMRT Irradiation in High-Risk, Clinically Non-Metastatic Prostate Cancer After Radical Prostatectomy
Inclusion Criteria:
Pathologically (histologically) proven diagnosis of prostate cancer progressing after
radical prostatectomy as indictated by one of the following:
- Postoperative PSA rising above 2.0ng/ml; or
- Postoperative PSA rising above 0.2 ng/ml with a surgical tumor Gleason score of 9 or
10; or
- Rapidly rising PSA profile with a doubling time less than 6 months.
- PSA Doubling Time (PSADT) should be calculated via the Calculation of PSA Doubling
Time page on the RTOG web site http://www.rtog.org/psadt.html
- Pathologic stage T2 - T4 N0 - N1, including no distant metastases, based upon the
following minimum diagnostic workup:
- History/physical examination within 8 weeks prior to registration
- Bone scan negative for bone metastases within 4 months prior to registration
- Abdominal imaging negative for metastases within 6 mothns prior to registration
- Zubrod Performance Status 0-1
- Age greater than or equal to 18 years.
- CBC/differential and PSA obtained within 4 weeks prior to registration, with adequate
bone marrow function defined as follows:
- Absolute Neutrophil Count (ANC) greater than or equal to 1,800 cells/mm³
- Platelets greater than or equal to 100,000 cells/mm³
- Hemoglobin (Hgb) greater than or equal to 8.0 g/dl (Note: The use of transfusion or
other intervention to achieve Hgb greater than or equal to 8.0 g/dl is permitted)
- Patients must be able to provide study specific informed consent prior to study
entry.
Exclusion Criteria:
- Biopsy evidence of M1 disease
- Presence of neuroendocrine features in any prostate cancer specimen
- Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free
for a minimum of 3 years
- Prior systemic chemotherapy for the study cancer (Note: Prior chemotherapy for a
different cancer is permitted.)
- Hormonal therapy initiated within the last 3 months
- Prior radiotherapy to the pelvic region that would result in overlap of radiation
therapy fields
- Severe, active co-morbidity, defined as follows:
- Unstable angina and/or congestive heart failure requiring hospitalization within the
last 6 months
- Transmural myocardial infarction within the last 6 months
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of
registration
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
(Note: Laboratory tests for liver function and coagulation parameters, however, are
not required for entry into this protocol.)
- Renal failure (Note: Laboratory tests for renal function, however, are not required
for entry into this protocol.)
- Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition (Note:
HIV testing is not required). The need to exclude patients with AIDS is necessary
because the treatments involved in this protocol may be significantly
immunosuppressive. Protocol-specific requirements may also exclude
immuno-compromised patients.