The true benefit of this MDT can only be assessed through randomization versus a control group. Secondly, the apparent achievement of MDT for oligometastatic PCa in postponing palliative ADT and in slowing down progression has only been observed in single arm studies. Choline positron emitting tomography (PET) with computed tomography (CT) might be a good candidate for the identification of low volume metastases with a pooled sensitivity and specificity exceeding 85% on a per-patient basis in the recurrent setting.
![stomp definition stomp definition](http://i1.ytimg.com/vi/LiRAwIYstuE/hqdefault.jpg)
Consequently, these imaging modalities are not recommended to screen patients for metastases until the PSA reaches 10 ng/ml 19. The traditional imaging studies such as bone scan and computed tomography lack sufficient sensitivity to detect low volume metastatic disease at low PSA levels. However, two major difficulties complicate assessment of the benefit of radical treatment for oligometastastatic prostate cancer recurrence.įirstly, the identification of patients with oligometastatic disease is challenging. In analogy with other solid tumours, eradication of these oligometastases by means of metastases directed therapy (MDT) with stereotactic body radiotherapy (SBRT) or surgery is a promising and emerging way to delay disease progression and postpone systemic treatment without major treatment toxicity. It is therefore an option in the EAU guidelines to suggest an active surveillance protocol for well-informed asymptomatic patients with PCA metastases. There is no proven overall survival benefit of immediate ADT over deferred ADT in metastatic patients. Although this strategy delays PCa progression, it is associated with numerous side effects impacting quality-of-life and general health. The first line treatment of metastatic PCa is lifelong androgen deprivation therapy (ADT) by means of surgical or medical castration. Prostate cancer (PCa) is the most frequent tumour in males and PCa death is attributed to metastatic disease in the majority of patients.
#Stomp definition trial
Trial registrationĬ identifier: NCT01558427 This is the first randomized phase 2 trial assessing the possibility of deferring palliative ADT with MDT in oligometastatic PCa recurrence. The secondary endpoints include progression-free survival, quality of life, toxicity and prostate-cancer specific survival. ADT will be started in both arms at time of polymetastatic disease (>3 metastatic lesions), local progression or symptoms. The primary endpoint is ADT-free survival. Active surveillance means 3-monthly PSA testing and re-imaging at PSA progression. Both surgery and SBRT are allowed as MDT. bone metastases) and PSA doubling time (≤3 vs. Patients will be stratified according to the location of metastasis (node vs. Patients with an oligometastatic recurrence, diagnosed on choline PET/CT after local treatment with curative intent, will be randomised in a 1:1 ratio between arm A: active surveillance only and arm B: MTD followed by active surveillance. The aim of this multicenter randomized phase II trial is to assess the impact of MTD on the start of palliative ADT compared to patients undergoing active surveillance.
![stomp definition stomp definition](https://www.setorvip.com.br/wp-content/uploads/2015/04/StompCapa.jpg)
However, the lack of a control group, selection bias and the use of adjuvant androgen deprivation therapy prevent strong conclusions from published studies. One of the goals of this approach is to delay the start of palliative androgen deprivation therapy (ADT), with its negative impact on quality of life.
![stomp definition stomp definition](https://live.staticflickr.com/4068/4485679057_575e34c68a.jpg)
![stomp definition stomp definition](https://merriam-webster.com/assets/mw/images/article/art-global-footer-recirc/stomp-3435-245f9af87a1109978611953547fe33d3@1x.jpg)
Metastases-directed therapy (MDT) with surgery or stereotactic body radiotherapy (SBRT) is emerging as a new treatment option for prostate cancer (PCa) patients with a limited number of metastases (≤3) at recurrence – so called “oligometastases”.