Metastasis-directed therapy in castration-refractory prostate cancer (MEDCARE)

Patients diagnosed with metastatic castration-refractory prostate cancer (mCRPC) rely on a limited number of therapeutic agents resulting in a median survival of 2-3 years. A subgroup of these patients presents with oligoprogressive disease, with a limited number of progressive lesions while other metastases are still controlled by ongoing systemic treatment. Preliminary data suggested that progression-directed therapy allow patients to remain on their current systemic treatment. PSMA (prostate specific membrane antigen) PET-CT are widespread available. While in patients with biochemical recurrence after primary treatment (castration sensitive patients) guidelines advise the use of PSMA PET-CT to evaluate clinical progression, the exact role of PSMA PET-CT in mCRPC is still unknown. MEDCARE is a prospective phase 2 trial that addresses the following research question: is progression-directed therapy able to postpone the need for next-line systemic therapy in mCRPC patients with oligometastatis and/or local progression? What is the clinical additional value of PSMA PET-CT concerning next-line systemic therapy free survival in mCRPC setting? The results from this trial will serve as a solid guidance for a randomized phase 3 trial in the near future.