Androgen Deprivation Therapy for Oligo-recurrent Prostate Cancer in Addition to radioTherapy

Inclusion criteria

• Histologically proven initial diagnosis of adenocarcinoma of the Prostate.
• Biochemical recurrence of prostate cancer following primary local prostate treatment (radical prostatectomy, primary radiotherapy or radical prostatectomy +/- prostate bed adjuvant salvage radiotherapy) according to the EAU guidelines 2018. BCR after surgery: PSA > 0.1ng/ml. BCR after radiotherapy: PSA nadir +2 ng/ml or 3 consequent rises in PSA level (after exclusion of possible bounce effect).
• Minimal 1 lesion and maximum 4 lesions (bone + lymph nodes) in total, without evidence of visceral metastases.

• Nodal relapse (N1) in the pelvis on PSMA-PET/CT with a maximum of 4 positive lymph nodes. The upper limit of the pelvis is defined as the aortic bifurcation.
• Nodal relapse (M1a) on PSMA-PET/CT above the aortic bifurcation with a maximum of 3 positive lymph nodes.
• Bone relapse on PSMA-PET/CT with a maximum of 3 lesions.
• Combination of a, b, c with a maximum of 4 metastases.
• Age > 18 years.
• Recent PSMA-PET/CT scan within 60 days prior to randomization.
• PSA < 10 ng/ml.
• In case of chronic use of finasteride the PSA value should be < 5 ng/ml.
• WHO performance state 0-2.
• Signed informed consent prior to registration/randomization.

Exclusion criteria

• Visceral metastases.
• PSA ≥ 10 ng/ml.
• PSA-doubling time ≤ 3 months.
• ADT or chemotherapy for recurrent PCa.
• Testosterone < 1.7 nmol/l
• Painful metastases needed pain medication (> level 1 pain medication) .
• Invasive active cancers other than superficial non-melanoma skin cancers.
• Inability or unwillingness to understand the information on trial-related topics, to give informed consent or to fill out QoL questionnaires.