This phase II trial studies how well prostate specific membrane antigen (PSMA) or fluciclovine positron emission tomography (PET)/computed tomography (CT) site-directed therapy works for treating patients with prostate cancer. PSMA or fluciclovine PET/CT may detect prostate cancer early and may help to show whether patients benefit from site directed treatment to PET detected abnormalities.
OUTLINE: Patients are assigned to 1 of 3 groups. GROUP I: Patients for whom initial fluciclovine or PSMA PET/CT does not reveal any abnormalities outside the prostatic fossa undergo PSA rechecks every 3 months, and undergo fluciclovine or PSMA PET/CT once PSA is \> 2 ng/ml. If still no abnormalities are found outside of the prostatic fossa, patients continue to undergo PSA rechecks every 3 months, and undergo fluciclovine or PSMA PET/CT once PSA is \> 5 ng/ml. Patients are off study for treatment plan once PSA reaches 10 ng/ml. GROUP II: Patients undergo fluciclovine or PSMA PET/CT and who have =\< 3 regions of metastatic disease outside of the prostatic fossa that are amenable to metastasis-directed therapy undergo lymphadenectomy or radiation therapy. Six to ten weeks after surgery, patients receive abiraterone acetate 1000 mg orally (PO) once daily (QD) and prednisone PO QD. Treatment repeats every 4 weeks for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients may start radiation therapy after 2 cycles of abiraterone acetate and prednisone. GROUP III: Patients undergo fluciclovine or PSMA PET/CT and who have \> 3 regions of metastatic disease receive abiraterone acetate and prednisone as in Group II. After completion of study treatment, patients are followed up at 37, 49, 61, 73, 85, 97, 109, and 121 weeks, at 36, 42, 48, 54, 60, and 66 months, and then annually thereafter.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Undergo fluciclovine PET/CT
Undergo lymphadenectomy
Undergo radiation therapy
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, United States
RECRUITINGFred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
RECRUITINGUndetectable PSA (< 0.2 ng/mL) rate
Time frame: At 2 years
Total testosterone
Time frame: Up to 7 years
Median time to reinitiation of antiandrogen therapy (ADT)
Time frame: Up to 7 years
Overall survival
Time frame: Up to 7 years
Number of patients with abnormalities within the prostatic fossa with PSA < 10 ng/mL
Time frame: Up to 7 years
Number of patients without abnormalities with PSA < 10 ng/mL
Time frame: Up to 7 years
Number of patients with PSA < 10 mg/mL and > 3 regions of metastatic prostate cancer on fluciclovine PET/CT
Time frame: Up to 7 years
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Given PO
Given PO
Undergo fluciclovine PET/CT
Given PO
Undergo PSMA PET scan