Phase III Study of Local or Systemic Therapy INtensification DIrected by PET in Prostate CAncer Patients With Post-ProstaTEctomy Biochemical Recurrence (INDICATE)
Summary
This phase III trial tests two questions by two separate comparisons of therapies. The first question is whether enhanced therapy (apalutamide in combination with abiraterone + prednisone) added to standard of care (prostate radiation therapy and short term androgen deprivation) is more effective compared to standard of care alone in patients with prostate cancer who experience biochemical recurrence (a rise in the blood level of prostate specific antigen \[PSA\] after surgical removal of the prostate cancer). A second question tests treatment in patients with biochemical recurrence who show prostate cancer spreading outside the pelvis (metastasis) by positron emission tomography (PET) imaging. In these patients, the benefit of adding metastasis-directed radiation to enhanced therapy (apalutamide in combination with abiraterone + prednisone) is tested. Diagnostic procedures, such as PET, may help doctors look for cancer that has spread to the pelvis. Androgens are hormones that may cause the growth of prostate cancer cells. Apalutamide may help fight prostate cancer by blocking the use of androgens by the tumor cells. Metastasis-directed targeted radiation therapy uses high energy rays to kill tumor cells and shrink tumors that have spread. This trial may help doctors determine if using PET results to deliver more tailored treatment (i.e., adding apalutamide, with or without targeted radiation therapy, to standard of care treatment) works better than standard of care treatment alone in patients with biochemical recurrence of prostate cancer.
Detailed description
PRIMARY OBJECTIVES: I. For patients without PET-evidence of extrapelvic metastases, to evaluate whether the addition of enhanced systemic therapy to standard of care (SOC) salvage radiation therapy (RT) could prolong progression-free survival (PFS). II. For patients with PET-evidence of extrapelvic metastases, to evaluate whether the addition of metastasis-directed RT to enhanced systemic therapy and SOC salvage RT could prolong PFS. III. To compare overall quality of life, measured by Functional Assessment of Cancer Therapy - Prostate (FACT-P) total score, at 6 months between the two sets of treatment arms (A with B and C with D). (QUALITY OF LIFE \[QOL\] OBJECTIVE) SECONDARY OBJECTIVES: I. To evaluate overall survival in each arm. II. To evaluate event-free survival in each arm. III. To evaluate time to prostate-specific antigen (PSA) progression in each arm. IV. To assess the incidence of adverse events with the addition of enhanced systemic therapy in patients without PET-evidence of extrapelvic metastases. V. To assess the incidence of adverse events with local ablative metastasis-directed RT for PET-positive metastatic disease in patients with PET-evidence of extrapelvic metastases. VI. To estimate the detection rate of PET at the patient and regional level, and to evaluate its concordance with the follow-up Food and Drug Administration (FDA)-approved conventional imaging modalities (CIM) (as available) considered standard-of-care per institution, including computed tomography (CT), bone scintigraphy, magnetic resonance imaging (MRI) and PET imaging. VII. To determine the distribution of PET-positive lesions among anatomic sites (prostate fossa, intrapelvic soft tissue/lymph node, extrapelvic soft tissue/lymph node, and bone metastases) in patients with post-radical prostatectomy (RP) biochemical recurrence (BCR), correlated with PSA (level, doubling time, velocity) and other relevant clinical parameters. VIII. To compare the change in overall QOL, measured by FACT-P total score, from baseline to 6 months between the two sets of treatment arms (A with B and C with D). (QOL OBJECTIVE) IX. To compare patient-reported fatigue (Functional Assessment of Chronic Illness Therapy \[FACIT\]-Fatigue scores) at 6 months between the two sets of treatment arms (A with B and C with D). (QOL OBJECTIVE) X. To compare patient-reported overall QOL (FACT-P scores), fatigue (FACIT-Fatigue scores) and pain interference (patient reported outcomes measurement information system \[PROMIS\] Pain Interference Short Form 4a) between the two sets of treatment arms (A with B and C with D) at the time of disease progression. (QOL OBJECTIVE) EXPLORATORY OBJECTIVES: I.To determine the value of repeat PET (PET2) at time of second PSA progression, clinical concern for progression, or 12 months after completion of enhanced systemic therapy, whichever comes first to assess response to therapy (enhanced systemic therapy +/- focal RT and/or androgen deprivation therapy \[ADT\]) compared to available standard response assessments (PSA and conventional imaging modalities \[CIM\]). II. To compare cognitive function, measured by FACT - cognitive function (Cog) peritoneal cancer index (PCI) and total scores, between the three treatment arms receiving enhanced systemic treatment with ADT and apalutamide (Arms B, C, and D) and antiandrogen therapy (ADT) alone (Arm A) at 6 and 12 month. (QOL OBJECTIVE) III. To compare the change in cognitive function, measured by change in FACT-Cog PCI and total scores, from baseline to 6 and baseline to 12 months, between the three treatment arms receiving enhanced systemic treatment with ADT and apalutamide (Arms B, C, and D) and ADT alone (Arm A) at 6 and 12 months. (QOL OBJECTIVE) IV. To characterize longitudinal change in cognitive function between baseline and 24 months in patients with prostate cancer receiving treatment for biochemical recurrence (BCR) and define clinical and disease related characteristics associated with greater cognitive change by the FACT-Cog PCI and total scores. (QOL OBJECTIVE) OUTLINE: STEP 0: Patients undergo SOC PET/CT or PET/MR scan at baseline. Patients randomized to Arms C or D and receiving fluciclovine F18 intravenously (IV) undergo a repeat PET2 at time of PSA progression or clinical concerns for progression or 12 months after completion of enhanced systemic therapy, whichever occurs first. Patients in Arm C or D using another tracer for PET1 do not undergo PET2. STEP 1: Patients are randomized to 1 of 4 arms based on results of fluciclovine F18 PET/CT or PET/MR in Step 0. ARM A (PET NEGATIVE FOR EXTRA PELVIC-METASTASES): Patients undergo SOC external beam radiation therapy (EBRT) for 6 months. Patients also receive goserelin acetate subcutaneously (SC), leuprolide acetate intramuscularly (IM), triptorelin IM, relugolix orally (PO), or degarelix SC for 6 months starting up to 3 months prior to EBRT but no later than 7 days after start of EBRT. All treatment continues for 6 months in the absence of disease progression or unacceptable toxicity. ARM B (PET NEGATIVE FOR EXTRA PELVIC-METASTASES): Patients undergo SOC EBRT and receive goserelin acetate SC, leuprolide acetate IM, triptorelin IM, relugolix PO, or degarelix SC as in Arm A. Patients also receive apalutamide PO once daily (QD) for 6 months in the absence of disease progression or unacceptable toxicity. ARM C: (PET POSITIVE FOR EXTRA PELVIC-METASTASES): Patients undergo SOC EBRT and receive goserelin acetate SC, leuprolide acetate IM, triptorelin IM, relugolix PO, or degarelix SC as in Arm A. Patients also receive apalutamide PO QD as in Arm B. ARM D (PET POSITIVE FOR EXTRA PELVIC-METASTASES): Patients undergo SOC EBRT and receive goserelin acetate SC, leuprolide acetate IM, triptorelin IM, relugolix PO, or degarelix SC as in Arm A and apalutamide PO QD as in Arm B. Patients also undergo stereotactic body radiation therapy (SBRT) or 3-dimensional (3D) conformal radiation therapy (CRT), intensity-modulated radiation therapy (IMRT) (including volume modulated arc therapy \[VMAT\]), and intensity-modulated proton therapy (IMPT) over 3-10 fractions in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for the first 2 years, every 6 months for years 3-5, and then annually for years 6-10.
Arms & interventions
- Radiation3-Dimensional Conformal Radiation Therapy
Undergo 3D CRT
- DrugApalutamide
Given PO
- ProcedureComputed Tomography
Undergo PET/CT
- DrugDegarelix
Given SC
- RadiationExternal Beam Radiation Therapy
Undergo EBRT
- OtherFluciclovine F18
Given IV
- DrugGoserelin Acetate
Given SC
- ProcedureIntensity-Modulated Proton Therapy
Undergo IMPT
- RadiationIntensity-Modulated Radiation Therapy
Undergo IMRT
- DrugLeuprolide Acetate
Given IM
- ProcedureMagnetic Resonance Imaging
Undergo PET/MR
- ProcedurePositron Emission Tomography
Undergo PET/CT or PET/MR
- OtherQuality-of-Life Assessment
Ancillary studies
- OtherQuestionnaire Administration
Ancillary studies
- DrugRelugolix
Given PO
- RadiationStereotactic Body Radiation Therapy
Undergo SBRT
- DrugTriptorelin
Given IM
- RadiationVolume Modulated Arc Therapy
Undergo VMAT
Outcome measures
Primary
Progression-free survival (PFS)
The power of the PFS analysis is 85% using one-sided 0.025 level stratified logrank test. The overall type I error will be controlled using an O'Brien-Fleming boundary function
Time frame: From randomization to radiographic progression by conventional imaging or positron emission tomography (PET), symptomatic disease or death, whichever occurs first, assessed up to 10 years
PFS prolongation in patients without PET-evidence of extrapelvic metastases
Will evaluate whether the addition of enhanced systemic therapy to standard of care salvage therapy could prolong PFS in this patient population. Will be an intention-to-treat analysis of all randomized patients and performed in parallel with patients with PET-evidence of extrapelvic metastases.
Time frame: Up to 10 years
PFS prolongation in patients with PET-evidence of extrapelvic metastases
Will evaluate whether the addition of metastasis-directed radiation therapy to standard of care salvage therapy and enhanced systemic therapy could prolong PFS in this patient population. Will be an intention-to-treat analysis of all randomized patients and performed in parallel without patients with PET-evidence of extrapelvic metastases.
Time frame: Up to 10 years
Quality of life (QOL)
Descriptive statistics will be used to characterize QOL over time in each arm.
Time frame: Up to 24 months
Secondary
Overall survival (OS)
Time frame: From randomization to death or date last known alive, assessed up to 10 years
Event-free survival
Time frame: From randomization to radiographic progression by conventional imaging or PET, symptomatic disease, or initiation of new treatment for the disease or death, whichever occurs first, assessed up to 10 years
Time to prostate-specific antigen (PSA) progression
Time frame: From randomization to documented PSA progression or radiographic progression, whichever occurs first, assessed up to 10 years
Incidence of adverse events
Time frame: Up to 10 years
Detection rate of fluciclovine F18 (18F-fluciclovine) PET
Time frame: At time of PSA recurrence, as clinically indicated or 12 months after completion of enhanced systemic therapy (whichever occurs first), assessed up to 10 years
Concordance of detection rate with the follow-up conventional imaging modalities (CIM)
Time frame: At time of PSA recurrence, as clinically indicated or 12 months after completion of enhanced systemic therapy (whichever occurs first), assessed up to 10 years
Distribution of 18F-fluciclovine PET-positive lesions among anatomic sites
Time frame: Baseline
Value of repeat PET to assess response to therapy compared to standard response assessments
Time frame: At time of second PSA recurrence or 12 months after completion of enhanced systemic therapy (whichever occurs first), assessed up to 10 years
Comparison - Functional Assessment of Cancer Therapy (FACT)- prostate (P)
Time frame: At baseline and 3, 6, 9, 12 months
Change in FACT-P and Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue
Time frame: Baseline up to 6 months
QOL Assessments at Progression
Time frame: Up to 10 years
FACT- cognitive functioning (Cog)
Time frame: Up to 12 months
Eligibility criteria
Study locations (342)
Anchorage Associates in Radiation Medicine
Anchorage, Alaska, 98508
Alaska Breast Care and Surgery LLC
Anchorage, Alaska, 99508
Alaska Oncology and Hematology LLC
Anchorage, Alaska, 99508
Alaska Women's Cancer Care
Anchorage, Alaska, 99508
Anchorage Oncology Centre
Anchorage, Alaska, 99508
Katmai Oncology Group
Anchorage, Alaska, 99508
Providence Alaska Medical Center
Anchorage, Alaska, 99508
Fairbanks Memorial Hospital
Fairbanks, Alaska, 99701
Cancer Center at Saint Joseph's
Phoenix, Arizona, 85004
Mercy Hospital Fort Smith
Fort Smith, Arkansas, 72903
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande, California, 93420
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California, 91505
Mercy Cancer Center - Carmichael
Carmichael, California, 95608
Mercy San Juan Medical Center
Carmichael, California, 95608
City of Hope Corona
Corona, California, 92882
City of Hope Comprehensive Cancer Center
Duarte, California, 91010
Mercy Cancer Center - Elk Grove
Elk Grove, California, 95758
UC San Diego Health System - Encinitas
Encinitas, California, 92024
UC San Diego Moores Cancer Center
La Jolla, California, 92093
City of Hope Antelope Valley
Lancaster, California, 93534
Los Angeles General Medical Center
Los Angeles, California, 90033
USC / Norris Comprehensive Cancer Center
Los Angeles, California, 90033
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, 90095
Mercy Cancer Center
Merced, California, 95340
VA Palo Alto Health Care System
Palo Alto, California, 94304
Mercy Cancer Center - Rocklin
Rocklin, California, 95765
Mercy Cancer Center - Sacramento
Sacramento, California, 95816
UC San Diego Medical Center - Hillcrest
San Diego, California, 92103
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo, California, 93401
Mission Hope Medical Oncology - Santa Maria
Santa Maria, California, 93444
City of Hope South Pasadena
South Pasadena, California, 91030
Saint Joseph's Medical Center
Stockton, California, 95204
City of Hope Upland
Upland, California, 91786
BASS Medical Group - Lennon
Walnut Creek, California, 94598
Woodland Memorial Hospital
Woodland, California, 95695
Rocky Mountain Cancer Centers-Aurora
Aurora, Colorado, 80012
Rocky Mountain Cancer Centers-Boulder
Boulder, Colorado, 80304
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, 80907
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado, 80907
Saint Francis Cancer Center
Colorado Springs, Colorado, 80923
AdventHealth Porter
Denver, Colorado, 80210
Presbyterian - Saint Lukes Medical Center - Health One
Denver, Colorado, 80218
Dillon Health Center/Shaw Cancer Center
Dillon, Colorado, 80435
Shaw Cancer Center
Edwards, Colorado, 81632
The Melanoma and Skin Cancer Institute
Englewood, Colorado, 80113
Saint Anthony Hospital
Lakewood, Colorado, 80228
Rocky Mountain Cancer Centers-Littleton
Littleton, Colorado, 80120
AdventHealth Littleton
Littleton, Colorado, 80122
Longmont United Hospital
Longmont, Colorado, 80501
AdventHealth Parker
Parker, Colorado, 80138
Saint Mary Corwin Medical Center
Pueblo, Colorado, 81004
Rocky Mountain Cancer Centers-Thornton
Thornton, Colorado, 80260
Saint Anthony North Hospital
Westminster, Colorado, 80023
Sibley Memorial Hospital
Washington D.C., District of Columbia, 20016
Moffitt Cancer Center-International Plaza
Tampa, Florida, 33607
Moffitt Cancer Center - McKinley Campus
Tampa, Florida, 33612
Moffitt Cancer Center
Tampa, Florida, 33612
Moffitt Cancer Center at Wesley Chapel
Wesley Chapel, Florida, 33544
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho, 83706
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho, 83605
Kootenai Health - Coeur d'Alene
Coeur d'Alene, Idaho, 83814
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho, 83619
Idaho Urologic Institute-Meridian
Meridian, Idaho, 83642
Saint Luke's Cancer Institute - Meridian
Meridian, Idaho, 83642
Saint Alphonsus Cancer Care Center-Nampa
Nampa, Idaho, 83687
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho, 83687
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho, 83854
Saint Luke's Cancer Institute - Twin Falls
Twin Falls, Idaho, 83301
Alton Memorial Hospital
Alton, Illinois, 62002
OSF Saint Anthony's Health Center
Alton, Illinois, 62002
Rush-Copley Medical Center
Aurora, Illinois, 60504
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Illinois CancerCare-Canton
Canton, Illinois, 61520
Memorial Hospital of Carbondale
Carbondale, Illinois, 62902
SIH Cancer Institute
Carterville, Illinois, 62918
Illinois CancerCare-Carthage
Carthage, Illinois, 62321
Centralia Oncology Clinic
Centralia, Illinois, 62801
Saint Mary's Hospital
Centralia, Illinois, 62801
Northwestern University
Chicago, Illinois, 60611
Rush MD Anderson Cancer Center
Chicago, Illinois, 60612
University of Illinois
Chicago, Illinois, 60612
Carle at The Riverfront
Danville, Illinois, 61832
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois, 62526
Decatur Memorial Hospital
Decatur, Illinois, 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
Illinois CancerCare-Dixon
Dixon, Illinois, 61021
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Crossroads Cancer Center
Effingham, Illinois, 62401
Illinois CancerCare-Eureka
Eureka, Illinois, 61530
Illinois CancerCare-Galesburg
Galesburg, Illinois, 61401
Western Illinois Cancer Treatment Center
Galesburg, Illinois, 61401
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
Rush MD Anderson Cancer Center at Rush Lisle
Lisle, Illinois, 60532
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Loyola University Medical Center
Maywood, Illinois, 60153
SSM Health Good Samaritan
Mount Vernon, Illinois, 62864
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois, 62269
Northwestern Medicine Oak Brook
Oak Brook, Illinois, 60523
Rush MD Anderson Cancer Center at Rush Oak Park
Oak Park, Illinois, 60304
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois, 61350
Illinois CancerCare-Pekin
Pekin, Illinois, 61554
Illinois CancerCare-Peoria
Peoria, Illinois, 61615
Methodist Medical Center of Illinois
Peoria, Illinois, 61636
Illinois CancerCare-Peru
Peru, Illinois, 61354
Valley Radiation Oncology
Peru, Illinois, 61354
Illinois CancerCare-Princeton
Princeton, Illinois, 61356
UW Health Carbone Cancer Center Rockford
Rockford, Illinois, 61114
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
Springfield Clinic
Springfield, Illinois, 62702
Springfield Memorial Hospital
Springfield, Illinois, 62781
Carle Cancer Center
Urbana, Illinois, 61801
The Carle Foundation Hospital
Urbana, Illinois, 61801
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
Illinois CancerCare - Washington
Washington, Illinois, 61571
Mercy Hospital
Cedar Rapids, Iowa, 52403
Oncology Associates at Mercy Medical Center
Cedar Rapids, Iowa, 52403
Central Care Cancer Center - Garden City
Garden City, Kansas, 67846
Central Care Cancer Center - Great Bend
Great Bend, Kansas, 67530
Mercy Hospital Pittsburg
Pittsburg, Kansas, 66762
Saint Joseph Hospital
Lexington, Kentucky, 40504
Saint Joseph Radiation Oncology Resource Center
Lexington, Kentucky, 40504
Saint Joseph Hospital East
Lexington, Kentucky, 40509
Jewish Hospital
Louisville, Kentucky, 40202
LSU Health Baton Rouge-North Clinic
Baton Rouge, Louisiana, 70805
Our Lady of the Lake Physician Group
Baton Rouge, Louisiana, 70808
MaineHealth Coastal Cancer Treatment Center
Bath, Maine, 04530
MaineHealth Maine Medical Center - Biddeford
Biddeford, Maine, 04005
MaineHealth Maine Medical Center - Portland
Portland, Maine, 04102
MaineHealth Cancer Care and IV Therapy - Sanford
Sanford, Maine, 04073
MaineHealth Cancer Care Center of York County
Sanford, Maine, 04073
MaineHealth Maine Medical Center- Scarborough
Scarborough, Maine, 04074
MaineHealth Cancer Care and IV Therapy - South Portland
South Portland, Maine, 04106
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, 21287
Suburban Hospital
Bethesda, Maryland, 20814
UM Baltimore Washington Medical Center/Tate Cancer Center
Glen Burnie, Maryland, 21061
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Minnesota Oncology Hematology PA-Chaska
Chaska, Minnesota, 55318
Mercy Hospital
Coon Rapids, Minnesota, 55433
Minnesota Oncology - Coon Rapids
Coon Rapids, Minnesota, 55433
Fairview Southdale Hospital
Edina, Minnesota, 55435
Minnesota Oncology - Edina
Edina, Minnesota, 55435
Unity Hospital
Fridley, Minnesota, 55432
Fairview Clinics and Surgery Center Maple Grove
Maple Grove, Minnesota, 55369
Minnesota Oncology - Maple Grove
Maple Grove, Minnesota, 55369
Minnesota Oncology Hematology PA-Maplewood
Maplewood, Minnesota, 55109
Saint John's Hospital - Healtheast
Maplewood, Minnesota, 55109
Abbott-Northwestern Hospital
Minneapolis, Minnesota, 55407
Hennepin County Medical Center
Minneapolis, Minnesota, 55415
Health Partners Inc
Minneapolis, Minnesota, 55454
Monticello Cancer Center
Monticello, Minnesota, 55362
North Memorial Medical Health Center
Robbinsdale, Minnesota, 55422
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota, 56303
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park, Minnesota, 55416
Regions Hospital
Saint Paul, Minnesota, 55101
United Hospital
Saint Paul, Minnesota, 55102
Saint Francis Regional Medical Center
Shakopee, Minnesota, 55379
Lakeview Hospital
Stillwater, Minnesota, 55082
Ridgeview Medical Center
Waconia, Minnesota, 55387
Rice Memorial Hospital
Willmar, Minnesota, 56201
Minnesota Oncology Hematology PA-Woodbury
Woodbury, Minnesota, 55125
Baptist Cancer Center-Grenada
Grenada, Mississippi, 38901
University of Mississippi Medical Center
Jackson, Mississippi, 39216
Baptist Memorial Hospital and Cancer Center-Union County
New Albany, Mississippi, 38652
Baptist Memorial Hospital and Cancer Center-Oxford
Oxford, Mississippi, 38655
Central Care Cancer Center - Bolivar
Bolivar, Missouri, 65613
Mercy Cancer Center - Cape Girardeau
Cape Girardeau, Missouri, 63703
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, 63376
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, 63141
Parkland Health Center - Farmington
Farmington, Missouri, 63640
MU Health Care Goldschmidt Cancer Center
Jefferson City, Missouri, 65109
Freeman Health System
Joplin, Missouri, 64804
Mercy Hospital Joplin
Joplin, Missouri, 64804
Lake Regional Hospital
Osage Beach, Missouri, 65065
Mercy Clinic-Rolla-Cancer and Hematology
Rolla, Missouri, 65401
Phelps Health Delbert Day Cancer Institute
Rolla, Missouri, 65401
Heartland Regional Medical Center
Saint Joseph, Missouri, 64506
Sainte Genevieve County Memorial Hospital
Sainte Genevieve, Missouri, 63670
Mercy Hospital Springfield
Springfield, Missouri, 65804
CoxHealth South Hospital
Springfield, Missouri, 65807
Washington University School of Medicine
St Louis, Missouri, 63110
Mercy Hospital South
St Louis, Missouri, 63128
Siteman Cancer Center-South County
St Louis, Missouri, 63129
Missouri Baptist Medical Center
St Louis, Missouri, 63131
Siteman Cancer Center at Christian Hospital
St Louis, Missouri, 63136
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Missouri Baptist Sullivan Hospital
Sullivan, Missouri, 63080
BJC Outpatient Center at Sunset Hills
Sunset Hills, Missouri, 63127
Billings Clinic Cancer Center
Billings, Montana, 59101
Bozeman Health Deaconess Hospital
Bozeman, Montana, 59715
Benefis Sletten Cancer Institute
Great Falls, Montana, 59405
Great Falls Clinic
Great Falls, Montana, 59405
Hi-Line Sletten Cancer Center
Havre, Montana, 59501
Logan Health Medical Center
Kalispell, Montana, 59901
Saint Patrick Hospital - Community Hospital
Missoula, Montana, 59802
Community Medical Center
Missoula, Montana, 59804
CHI Health Good Samaritan
Kearney, Nebraska, 68847
Alegent Health Immanuel Medical Center
Omaha, Nebraska, 68122
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska, 68124
Alegent Health Lakeside Hospital
Omaha, Nebraska, 68130
Creighton University Medical Center
Omaha, Nebraska, 68131
Cooper Hospital University Medical Center
Camden, New Jersey, 08103
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
Robert Wood Johnson University Hospital Somerset
Somerville, New Jersey, 08876
Community Medical Center
Toms River, New Jersey, 08755
MD Anderson Cancer Center at Cooper-Voorhees
Voorhees Township, New Jersey, 08043
Northwell Health Imbert Cancer Center
Bay Shore, New York, 11706
Northwell Health Physicians Partners Radiation Medicine at Queens
Forest Hills, New York, 11375
Northwell Health/Center for Advanced Medicine
Lake Success, New York, 11042
Mount Sinai Union Square
New York, New York, 10003
Mount Sinai Chelsea
New York, New York, 10011
Mount Sinai West
New York, New York, 10019
Mount Sinai Hospital
New York, New York, 10029
New York Proton Center
New York, New York, 10035
Manhattan Eye Ear and Throat Hospital
New York, New York, 10065
Lenox Hill Hospital
New York, New York, 10075
Queens Cancer Center
Rego Park, New York, 11374
Phelps Memorial Hospital Center
Sleepy Hollow, New York, 10591
Stony Brook University Medical Center
Stony Brook, New York, 11794
Montefiore Medical Center-Einstein Campus
The Bronx, New York, 10461
Montefiore Medical Center-Weiler Hospital
The Bronx, New York, 10461
Montefiore Medical Center - Moses Campus
The Bronx, New York, 10467
Westchester Medical Center
Valhalla, New York, 10595
ECU Health Oncology Kenansville
Kenansville, North Carolina, 28349
ECU Health Oncology Kinston
Kinston, North Carolina, 28501
ECU Health Oncology Richlands
Richlands, North Carolina, 28574
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
Good Samaritan Hospital - Cincinnati
Cincinnati, Ohio, 45220
Bethesda North Hospital
Cincinnati, Ohio, 45242
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
Saint Charles Health System
Bend, Oregon, 97701
Clackamas Radiation Oncology Center
Clackamas, Oregon, 97015
Providence Cancer Institute Clackamas Clinic
Clackamas, Oregon, 97015
Bay Area Hospital
Coos Bay, Oregon, 97420
Legacy Mount Hood Medical Center
Gresham, Oregon, 97030
Providence Newberg Medical Center
Newberg, Oregon, 97132
Providence Willamette Falls Medical Center
Oregon City, Oregon, 97045
Legacy Good Samaritan Hospital and Medical Center
Portland, Oregon, 97210
Providence Portland Medical Center
Portland, Oregon, 97213
Providence Saint Vincent Medical Center
Portland, Oregon, 97225
Oregon Health and Science University
Portland, Oregon, 97239
Legacy Meridian Park Hospital
Tualatin, Oregon, 97062
UPMC Altoona
Altoona, Pennsylvania, 16601
UPMC-Heritage Valley Health System Beaver
Beaver, Pennsylvania, 15009
Crozer-Keystone Regional Cancer Center at Broomall
Broomall, Pennsylvania, 19008
Carlisle Regional Cancer Center
Carlisle, Pennsylvania, 17015
Delaware County Memorial Hospital
Drexel Hill, Pennsylvania, 19026
Fox Chase Cancer Center - East Norriton Hospital Outpatient Center
East Norriton, Pennsylvania, 19401
UPMC Hillman Cancer Center Erie
Erie, Pennsylvania, 16505
UPMC Cancer Center at UPMC Horizon
Farrell, Pennsylvania, 16121
Fox Chase Cancer Center Buckingham
Furlong, Pennsylvania, 18925
Crozer Regional Cancer Center at Brinton Lake
Glen Mills, Pennsylvania, 19342
UPMC Cancer Centers - Arnold Palmer Pavilion
Greensburg, Pennsylvania, 15601
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg, Pennsylvania, 17109
Penn State Milton S Hershey Medical Center
Hershey, Pennsylvania, 17033-0850
UPMC-Johnstown/John P. Murtha Regional Cancer Center
Johnstown, Pennsylvania, 15901
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
Mechanicsburg, Pennsylvania, 17050
UPMC Cancer Center - Monroeville
Monroeville, Pennsylvania, 15146
UPMC Hillman Cancer Center in Coraopolis
Moon Township, Pennsylvania, 15108
UPMC Cancer Center-Natrona Heights
Natrona Heights, Pennsylvania, 15065
UPMC Hillman Cancer Center - New Castle
New Castle, Pennsylvania, 16105
Penn Presbyterian Medical Center
Philadelphia, Pennsylvania, 19104
University of Pennsylvania/Abramson Cancer Center
Philadelphia, Pennsylvania, 19104
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Fox Chase Cancer Center
Philadelphia, Pennsylvania, 19111
Temple University Hospital
Philadelphia, Pennsylvania, 19140
UPMC-Magee Womens Hospital
Pittsburgh, Pennsylvania, 15213
UPMC-Saint Margaret
Pittsburgh, Pennsylvania, 15215
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, 15232
UPMC-Shadyside Hospital
Pittsburgh, Pennsylvania, 15232
UPMC-Passavant Hospital
Pittsburgh, Pennsylvania, 15237
UPMC-Saint Clair Hospital Cancer Center
Pittsburgh, Pennsylvania, 15243
UPMC Cancer Center at UPMC Northwest
Seneca, Pennsylvania, 16346
UPMC Cancer Center-Uniontown
Uniontown, Pennsylvania, 15401
UPMC Uniontown Hospital Radiation Oncology
Uniontown, Pennsylvania, 15401
UPMC Washington Hospital Radiation Oncology
Washington, Pennsylvania, 15301
UPMC Susquehanna
Williamsport, Pennsylvania, 17701
UPMC Memorial
York, Pennsylvania, 17408
Medical University of South Carolina
Charleston, South Carolina, 29425
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Parkland Memorial Hospital
Dallas, Texas, 75235
UT Southwestern Simmons Cancer Center - RedBird
Dallas, Texas, 75237
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
Tarrant County Hospital District/JPS Health Network
Fort Worth, Texas, 76104
UT Southwestern/Simmons Cancer Center-Fort Worth
Fort Worth, Texas, 76104
UT Southwestern Clinical Center at Richardson/Plano
Richardson, Texas, 75080
Audie L Murphy VA Hospital
San Antonio, Texas, 78229
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
University of Virginia Cancer Center
Charlottesville, Virginia, 22908
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
Providence Regional Cancer System-Aberdeen
Aberdeen, Washington, 98520
PeaceHealth Saint Joseph Medical Center
Bellingham, Washington, 98225
Providence Regional Cancer System-Centralia
Centralia, Washington, 98531
Swedish Cancer Institute-Edmonds
Edmonds, Washington, 98026
Providence Regional Cancer Partnership
Everett, Washington, 98201
Swedish Cancer Institute-Issaquah
Issaquah, Washington, 98029
Kadlec Clinic Hematology and Oncology
Kennewick, Washington, 99336
Providence Regional Cancer System-Lacey
Lacey, Washington, 98503
PeaceHealth Saint John Medical Center
Longview, Washington, 98632
Skagit Regional Health Cancer Care Center
Mount Vernon, Washington, 98274
Swedish Medical Center-Ballard Campus
Seattle, Washington, 98107
Fred Hutchinson Cancer Center
Seattle, Washington, 98109
Swedish Medical Center-Cherry Hill
Seattle, Washington, 98122-5711
Swedish Medical Center-First Hill
Seattle, Washington, 98122
FHCC at Northwest Hospital
Seattle, Washington, 98133
University of Washington Medical Center - Montlake
Seattle, Washington, 98195
PeaceHealth United General Medical Center
Sedro-Woolley, Washington, 98284
Saint Michael Cancer Center
Silverdale, Washington, 98383
Cancer Care Northwest - Spokane South
Spokane, Washington, 99202
Cancer Care Northwest-North Spokane
Spokane, Washington, 99218
PeaceHealth Southwest Medical Center
Vancouver, Washington, 98664
Legacy Cancer Institute Medical Oncology and Day Treatment
Vancouver, Washington, 98684
Legacy Salmon Creek Hospital
Vancouver, Washington, 98686
Providence Saint Mary Regional Cancer Center
Walla Walla, Washington, 99362
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
University of Wisconsin Carbone Cancer Center - Johnson Creek
Johnson Creek, Wisconsin, 53038
William S Middleton VA Medical Center
Madison, Wisconsin, 53705
University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
Madison, Wisconsin, 53718
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin, 54548
Cancer Center of Western Wisconsin
New Richmond, Wisconsin, 54017
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander, Wisconsin, 54501
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Aspirus Cancer Care - Stevens Point
Stevens Point, Wisconsin, 54481
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin, 54482
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494
Memorial Hospital of Laramie County
Cheyenne, Wyoming, 82001
Welch Cancer Center
Sheridan, Wyoming, 82801
References
- Morgan TM, Boorjian SA, Buyyounouski MK, Chapin BF, Chen DYT, Cheng HH, Chou R, Jacene HA, Kamran SC, Kim SK, Kirkby E, Luckenbaugh AN, Nathanson BJ, Nyame YA, Posadas EM, Tran PT, Chen RC. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy. J Urol. 2024 Apr;211(4):518-525. doi: 10.1097/JU.0000000000003891. Epub 2024 Feb 29.(PubMed)