PSMA-Directed Para-Aortic Radiation Therapy for Oligorecurrent Prostate Cancer

Eligibility Criteria

• 1. Histologically proven prostate adenocarcinoma
• 2. Male, ≥ 18 years old
• 3. Oligorecurrent disease limited to the sub-diaphragmatic region with or without pelvic lymph nodes
• * a. No more than a total of 5 lesions on PSMA PET/CT scan (each lesion defined as positive with standardized uptake value (SUV) \> liver uptake and CT scan correlate)
• * b. No disease outside of the pelvic and sub-diaphragmatic para-aortic lymph nodes
• * c. At least one lesion in the sub-diaphragmatic para-aortic lymph nodes
• * d. Non-bulky nodal disease (ie, tumor \<5 cm)
• 4. Prior pelvic radiation with disease response
• * a. Definitive radiation therapy to the prostate with or without treatment of the pelvic lymph nodes and/or
• * b. Salvage or adjuvant radiation therapy to the prostate bed following prostatectomy with or without treatment of the pelvic lymph nodes
• 5. Hormone-sensitive prostate cancer
• 6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2
• 7. Ability to understand the investigational nature, potential risks and benefits of the research study, and willingness to sign the written informed consent and HIPAA document(s)
• 8. Willingness to fill out quality of life and psychosocial forms
• 9. Willingness to participate in our institution's Prostate Cancer Database Protocol (ID# 20090767)
• 1. No pathological diagnosis of prostate adenocarcinoma
• 2. Patient has more than 5 sites of metastatic disease
• 3. Patient has history of bone and/or visceral metastasis
• 4. No evidence of disease in the para-aortic lymph nodes
• 5. No staging with PSMA PET/CT scan
• 6. History of prior radiation therapy outside the pelvis for prostate cancer
• 7. Bulky nodal disease \>5 cm in tumor size
• 8. Androgen deprivation therapy (ADT) or chemotherapy in the three months prior to staging PSMA PET/CT scan (suggesting oligoprogressive disease, rather than true oligorecurrent disease) or at time of study enrollment
• 9. Suspicious radiologic evidence of disease in the prostate on staging PSMA PET/CT scan without confirmatory negative prostate biopsy
• 10. Implanted hardware which limits treatment planning or delivery (determined by treating physician)
• 11. Castration-resistant prostate cancer (history of rising PSA with serum testosterone level \<50 ng/dL)
• 12. Patients with ECOG performance status \> 2
• 13. History of inflammatory bowel disease
• 14. History of malignancy other than prostate cancer except for non-melanoma skin cancer
• 15. Patients unable to consent or are prisoners
• 16. Unwilling to fill out quality of life and psychosocial forms
• 17. Participants with impaired decision-making capacity