Radiation + Androgen Suppression for Prostate Cancer

Recruiting at 5 trial locations

Overseen By Matthew Morocco

Age: 18+

Sex: Male

Trial Phase: Phase 3

Sponsor: Proton Collaborative Group

Must not be taking: Anticoagulants

Disqualifiers: Previous prostate surgery, Pelvic radiation, Androgen therapy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 6 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 28

Duration: 6 months

192 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores treatments for men with prostate cancer that hasn't spread beyond the prostate. It compares proton beam radiation therapy alone with a combination of this radiation and androgen suppression therapy, which reduces male hormones. The goal is to determine which approach is more effective or has fewer side effects. Men diagnosed with intermediate-risk prostate cancer who have not undergone previous prostate cancer surgeries or treatments might be suitable for this trial. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants a chance to contribute to potentially groundbreaking treatment advancements.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are on certain blood thinners like warfarin or Plavix unless they can be stopped for treatment-related reasons.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that proton beam radiation therapy is generally manageable for prostate cancer patients. Studies have found that this treatment usually has mild side effects and effectively controls cancer.

When combined with androgen suppression (a treatment that lowers male hormones), research indicates proton therapy is safe, though its effectiveness and side effects are still under investigation. Androgen suppression is often used and generally safe, but it can cause side effects like tiredness and changes in sexual function.

Overall, both treatments seem to be safe options for prostate cancer patients, with manageable side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about the combination of proton beam radiation therapy with androgen suppression for prostate cancer because it offers a potentially more effective approach than current treatments. While traditional therapies might involve either radiation or hormone therapy alone, this combo targets the cancer from two fronts: radiation to destroy cancer cells and androgen suppression to reduce the hormones that fuel cancer growth. Proton therapy is particularly promising as it delivers precise radiation doses with minimal damage to surrounding healthy tissue. This dual approach aims to enhance treatment effectiveness and improve patient outcomes.

What evidence suggests that this trial's treatments could be effective for prostate cancer?

Research has shown that combining radiation with hormone therapy, specifically Androgen Suppression Therapy with Radiation, can benefit prostate cancer patients. Studies have found that this combination increases survival rates and reduces the risk of cancer spreading. Early results suggest it also lowers the likelihood of cancer recurrence. Additionally, patients receiving both treatments tend to live longer than those receiving only radiation, which is another treatment arm in this trial. These findings are particularly encouraging for patients with intermediate-risk prostate cancer. ^{3 4 5 6 7}

Who Is on the Research Team?

Carlos Vargas, MD

Principal Investigator

Proton Collaborative Group

Are You a Good Fit for This Trial?

Men with intermediate-risk prostate cancer who have not had previous prostate surgery, androgen suppression therapy, or pelvic radiation. They must be in good physical condition (ECOG 0-1), have a Gleason Score of 7, PSA levels between 10-20 ng/ml, T stage T2b-T2c, and no major medical issues that could affect the study.

Inclusion Criteria

My prostate cancer has a Gleason score between 2 and 7, based on more than 6 biopsy samples.

My PSA level is 20 ng/ml or lower, measured within the last 3 months.

I can start treatment within 56 days of being chosen for the trial.

Exclusion Criteria

I had a heart attack in the last 6 months.

Major medical, addictive or psychiatric illness which in the investigator's opinion, will prevent the consent process, completion of the treatment and/or interfere with follow-up (Consent by legal authorized representative is not permitted for this study)

My pelvic lymph nodes are enlarged but have tested negative for cancer.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive hypofraction proton therapy alone or with androgen suppression therapy

6 months

28 treatments (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 years

Annual visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Androgen Suppression Therapy
• Proton Beam Radiation Therapy

Trial Overview The trial is testing hypofraction proton therapy alone versus proton therapy combined with androgen suppression. Participants will receive either just the radiation treatment or both treatments to see which is more effective at treating localized prostate cancer.

How Is the Trial Designed?

Group I: Radiation + Androgen Suppression Experimental Treatment 2 Interventions

Androgen Suppression Therapy x 6 months + Radiation

Group II: Radiation Alone Active Control 1 Intervention

Proton Radiation Total Dose=70 Gy(RBE) OR High Dose Radiation with IMRT Alone=81 Gy OR Intraoperative LDR Brachytherapy and IMRT=45 Gy

Proton Beam Radiation Therapy is already approved in European Union, United States, Canada, Japan, China, Switzerland for the following indications:

Approved in European Union as Proton Therapy for:

• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Gastroesophageal junction tumors

Approved in United States as Proton Therapy for:

• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Gastroesophageal junction tumors

Approved in Canada as Proton Therapy for:

• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Gastroesophageal junction tumors

Approved in Japan as Proton Therapy for:

• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Gastroesophageal junction tumors

Approved in China as Proton Therapy for:

• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Gastroesophageal junction tumors

Approved in Switzerland as Proton Therapy for:

• Esophageal adenocarcinoma
• Esophageal squamous cell carcinoma
• Gastroesophageal junction tumors

Who Is Running the Clinical Trial?

Proton Collaborative Group

Lead Sponsor

Trials

10

Recruited

41,100+

Published Research Related to This Trial

In a study of 192 prostate cancer patients treated with proton beam therapy (PBT) over a median follow-up of 1.7 years, only 5 patients experienced grade 3 toxicity, with no occurrences of grade 4 or 5 toxicity, indicating a high safety profile for this treatment.

Patient-reported outcomes showed stable urinary function post-treatment, while sexual health scores declined slightly at 1 year but did not worsen thereafter; bowel function scores also decreased but stabilized, suggesting manageable side effects associated with PBT.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early toxicity and patient reported quality-of-life in patients receiving proton therapy for localized prostate cancer: a single institutional review of prospectively recorded outcomes. Lee, HJ., Macomber, MW., Spraker, MB., et al.[2019]

Proton radiation therapy is gaining popularity for localized prostate cancer due to its ability to deliver high doses to the tumor while minimizing damage to surrounding healthy tissue, thanks to the unique Bragg peak effect.

While proton therapy has shown effectiveness in dose escalation for prostate cancer, it currently lacks clear dosimetric superiority over traditional X-ray intensity-modulated radiation therapy, although advancements in techniques like pencil-beam scanning may enhance its benefits in the future.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proton radiation for localized prostate cancer. Coen, JJ., Zietman, AL.[2021]

In a study of 276,880 men with localized prostate cancer, proton beam therapy (PBT) was associated with significantly better overall survival (OS) compared to photon-based external-beam radiation therapy (EBRT), with an adjusted hazard ratio of 1.72, indicating a higher risk of worse outcomes with EBRT.

PBT showed similar OS outcomes to brachytherapy (BT), particularly benefiting younger men (≤ 65 years) with low-risk disease, suggesting that PBT may be a more effective treatment option for certain patient subgroups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy. Liu, Y., Patel, SA., Jani, AB., et al.[2021]

In a study of 289 prostate cancer patients, hypofractionated proton beam therapy (PBT) showed no significant differences in acute adverse event rates or quality of life, as measured by the International Prostate Symptom Score (IPSS), compared to conventionally fractionated PBT.

The study evaluated patients treated with different doses (2.0, 2.5, and 3.0 Gy RBE per fraction) and found that factors like diabetes, age, and androgen deprivation therapy did not influence the IPSS outcomes, suggesting that hypofractionated PBT is a safe option without increased toxicity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute toxicity and patient-reported symptom score after conventional versus moderately hypofractionated proton therapy for prostate cancer. Iizumi, T., Ishikawa, H., Sekino, Y., et al.[2022]

Proton beam therapy (PBT) as a standalone treatment for localized prostate cancer showed a high 5-year progression-free survival rate of 97% for intermediate-risk patients and 83% for high-risk patients, indicating its efficacy.

The treatment was associated with low rates of severe side effects, with only 3.9% of patients experiencing significant gastrointestinal toxicity and 23.5% experiencing acute genitourinary toxicity, suggesting that PBT can effectively preserve patients' quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proton Beam Therapy Alone for Intermediate- or High-Risk Prostate Cancer: An Institutional Prospective Cohort Study. Arimura, T., Yoshiura, T., Matsukawa, K., et al.[2020]

In intermediate-risk prostate cancer patients (520 participants), androgen deprivation therapy (ADT) significantly improved biochemical relapse-free rates, particularly in those with multiple risk factors, indicating that short-term ADT (≤6 months) is beneficial.

For high-risk prostate cancer patients (555 participants), longer ADT durations (>6 months) were associated with better biochemical relapse-free rates, especially for those with multiple high-risk factors, suggesting that ADT for ≥21 months may be optimal when combined with high-dose proton beam therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimal Androgen Deprivation Therapy Combined with Proton Beam Therapy for Prostate Cancer: Results from a Multi-Institutional Study of the Japanese Radiation Oncology Study Group. Murakami, M., Ishikawa, H., Shimizu, S., et al.[2020]

Proton beam therapy (PBT) allows for higher radiation doses to be delivered to prostate cancer tissues while reducing exposure to surrounding healthy organs, making it a safer option for treatment.

Interest in PBT is growing due to improvements in treatment delivery systems and increased availability, highlighting the need for a comprehensive understanding of its effectiveness and technical aspects in treating localized prostate cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proton beam therapy for the treatment of prostate cancer. Pugh, TJ., Lee, AK.[2018]

In a study of 180 prostate cancer patients treated between 1972 and 1979, those receiving a proton beam boost along with conventional x-ray therapy were able to receive a higher dose to the tumor without increasing side effects, demonstrating the safety of this approach.

Despite the increased dose delivered to the tumor using the proton beam, there were no significant differences in patient survival, disease-free survival, or local recurrence-free survival compared to those treated with conventional x-ray therapy, suggesting similar efficacy between the two methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Protons or megavoltage X-rays as boost therapy for patients irradiated for localized prostatic carcinoma. An early phase I/II comparison. Duttenhaver, JR., Shipley, WU., Perrone, T., et al.[2019]

In a study involving 150 patients with low- and intermediate-risk prostate cancer, conformal proton therapy did not significantly alter serum testosterone levels within 24 months after treatment.

The median testosterone levels remained stable post-treatment, indicating that proton therapy may not have the same testosterone-suppressing effects observed with traditional x-ray radiotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proton radiotherapy for prostate cancer is not associated with post-treatment testosterone suppression. Nichols, RC., Morris, CG., Hoppe, BS., et al.[2022]

In a study of 27,647 Medicare beneficiaries with prostate cancer, proton radiotherapy (PRT) was associated with lower genitourinary toxicity at 6 months compared to intensity-modulated radiotherapy (IMRT), but this difference disappeared by 12 months post-treatment.

PRT was significantly more expensive than IMRT, with median Medicare reimbursements of $32,428 for PRT compared to $18,575 for IMRT, yet no long-term differences in toxicity were observed between the two treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity. Yu, JB., Soulos, PR., Herrin, J., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7352923/

Optimal Androgen Deprivation Therapy Combined with ... A combination of ADT for 5–7 months and intensity-modulated RT at ≥81 Gy improved bRF survival, distant metastasis, and PCSM rates in patients ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2452109422002482

Initial Quality of Life and Toxicity Analysis of a Randomized ... Multiple studies have demonstrated improved outcomes in patients with intermediate-risk prostate cancer when external beam radiation therapy (RT) is combined ...

3. frontiersin.org frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.695647/full

Androgen Deprivation Therapy Combined With Particle ... We are conducting a systematic review on biochemical disease-free survival, overall survival, and morbidity after combined particle therapy and ADT for ...

4. tcr.amegroups.org tcr.amegroups.org/article/view/597/html

Proton beam radiation therapy of prostate cancer - Rossi This paper will provide a concise review of the history of proton beam therapy of prostate cancer, discuss the most recently published clinical data, examine ...

5. redjournal.org redjournal.org/article/S0360-3016(25)06022-5/fulltext

Phase 3 Trial of Dose-Escalated Radiation Therapy and ... Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8489490/

Consensus Statement on Proton Therapy for Prostate Cancer Proton therapy is a promising but controversial treatment in the management of prostate cancer. Despite its dosimetric advantages when compared with photon ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1538472125000017

Safety and early outcomes of proton therapy and low-dose ... At 45 months' follow-up time, treatment with PT and LDR boost led to high control rates and low toxicity for men with prostate cancer.