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Zapping the handful of spots that show up when prostate cancer comes back put off the day hormone therapy was needed, by about eight months, in a small trial.
STOMP randomised 62 men with asymptomatic biochemical recurrence and three or fewer extracranial metastases on choline PET-CT to surveillance or metastasis-directed therapy of all detected lesions by surgery or stereotactic body radiotherapy. Randomisation was balanced on PSA doubling time (3 months or less against more than 3) and on nodal against non-nodal metastases. Androgen deprivation was started at symptomatic progression, progression to more than three metastases, or local progression of known metastases.
At a median 3 years (interquartile range 2.3 to 3.75), median androgen deprivation-free survival was 13 months (80 percent confidence interval 12 to 17) with surveillance and 21 months (80 percent confidence interval 14 to 29) with metastasis-directed therapy, hazard ratio 0.60 (80 percent confidence interval 0.40 to 0.90, log-rank p=0.11). The 80 percent confidence interval is what the trial was designed to report and is much wider than the conventional 95 percent.
Quality of life was similar between arms at baseline, 3 months and 1 year. Six men in the treatment arm had grade 1 toxicity and no grade 2 to 5 toxicity was observed.
STOMP is a signal, not a proof. It changed practice anyway, partly because PSMA PET made small-volume recurrence visible in far more men, and the phase 3 trials that should settle it are still running.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
62 randomised.
Confidence intervals were prespecified at 80 percent: 14 to 29 and 12 to 17 months, hazard ratio 0.40 to 0.90.
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Androgen deprivation-free survival (median)primary | Metastasis-directed therapy | - | 21 months | 0.6 | 0.11 | link |
| Surveillance | - | 13 months |
Shares EMBARK, Biochemical recurrence (BCR), Androgen deprivation therapy (ADT), Biochemical recurrence of prostate cancer.
Shares Biochemical recurrence (BCR), Oligometastatic disease, Biochemical recurrence of prostate cancer, SBRT / SABR (stereotactic radiotherapy).
Shares Biochemical recurrence (BCR), Oligometastatic disease, SBRT / SABR (stereotactic radiotherapy), Prostate cancer.
Shares EMBARK, Biochemical recurrence (BCR), Biochemical recurrence of prostate cancer, Metastatic hormone-sensitive prostate cancer.
Shares PSA kinetics: PSA doubling time and PSA density, Biochemical recurrence of prostate cancer, Prostate cancer.
Shares EMBARK, Androgen deprivation therapy (ADT), Biochemical recurrence of prostate cancer, Prostate cancer.
Shares Biochemical recurrence (BCR), Androgen deprivation therapy (ADT), Prostate cancer.