A Study of Salvage Radiotherapy With or Without Enzalutamide in Recurrent Prostate Cancer Following Surgery (STEEL)

  • End date
    Sep 15, 2029
  • participants needed
  • sponsor
    RTOG Foundation, Inc.
Updated on 13 March 2022
platelet count
growth factor
antiandrogen therapy
androgen suppression
prostate specific antigen
luteinizing hormone-releasing hormone agonist
serum testosterone
recurrent prostate cancer


Patients with post-prostatectomy PSA (Prostate Specific Antigen) recurrences with aggressive disease features will receive salvage radiation therapy and standard androgen deprivation therapy (ADT) or enhanced ADT to determine if there is any improvement in progression-free survival when enhanced ADT is used compared to standard ADT.



To determine whether, in men with post-prostatectomy PSA (prostate specific antigen) recurrences with aggressive disease features, salvage radiotherapy (SRT) with enhanced androgen deprivation therapy (ADT), consisting of enzalutamide (MDV3100) and a GnRH analog, will improve progression-free survival compared to SRT with standard GnRH analog -based ADT.

Condition Prostate Cancer
Treatment bicalutamide, radiation therapy, Enzalutamide, GnRH analog
Clinical Study IdentifierNCT03809000
SponsorRTOG Foundation, Inc.
Last Modified on13 March 2022


Yes No Not Sure

Inclusion Criteria

Pathologically (histologically) proven adenocarcinoma confirmed by prostatectomy performed within 10 years prior to registration and any type of radical prostatectomy is permitted, including retropubic, perineal, laparoscopic or robotically assisted
PSA level (≥ 0.2 ng/mL) within 90 days prior to registration. GnRH analog may be started no more than 42 days prior study entry, but patients must have a PSA ≥ 0.2 ng/mL prior to starting ADT
Hemoglobin ≥ 9.0 g/dL, independent of transfusion and/or growth factors within 90 days prior to registration
Platelet count ≥ 75,000 x 10^9/µL independent of transfusion and/or growth factors within 90 days prior to registration
At least 1 of the following aggressive features
Gleason score of 8-10 (note any Gleason score is eligible)
Seminal vesicle invasion (SVI) (note any pT stage [AJCC v8.0] is eligible but a pT stage
≥ pT3b is considered aggressive)
Locoregional node involvement at radical prostatectomy (pN1)
Persistently elevated PSA post-RP nadir (PEPP) defined as PSA > 0.1 ng/mL after radical prostatectomy
Serum albumin ≥ 3.0 g/dL within 90 days prior to registration
GFR ≥35 mL/min estimated by Cockcroft-Gault or measured directly by 24 hour urine creatinine within 90 days prior to registration
Serum total bilirubin ≤1.5 × ULN (Note: In subjects with Gilbert's syndrome, if total bilirubin is >1.5 × ULN, measure direct and indirect bilirubin and if direct bilirubin is ≤1.5 × ULN, subject is eligible) within 90 days prior to registration
Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) <2.5 × ULN within 90 days prior to registration
Testosterone >50 ng/dL within 90 days prior to registration. Prior androgen deprivation (GnRH analog and/or non-steroidal antiandrogen) therapy is allowed provided that serum testosterone concentration must be ≥ 50 ng/dL prior to registration or starting ADT, whichever occurs first; 5-alpha reductase inhibitors will not impact eligibility, but must be discontinued prior to starting protocol treatment
History and physical with ECOG Performance Status 0-1 or within 90 days prior to registration

Exclusion Criteria

Definitive clinical or radiologic evidence of metastatic disease with the exception of locoregional lymph nodes
Prior invasive malignancy (except non-melanomatous skin cancer carcinoma in situ of the male breast, penis, oral cavity, or stage Ta of the bladder, or stage I completely resected melanoma) unless disease free for a minimum of 2 years)
Prior systemic chemotherapy for the study cancer. Note: prior chemotherapy for a different cancer is allowable
Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
History of any of the following
Documented inflammatory bowel disease
Transmural myocardial infarction within the last 4 months prior to registration
Unstable angina and/or congestive heart failure requiring hospitalization within the last 4 months prior to registration
New York Heart Association Functional Classification III/IV within 4 months prior to registration
History of loss of consciousness or transient ischemic attack within 12 months prior to randomization
History of seizure disorder or condition that may predispose to seizure (e.g. prior cortical stroke or significant brain trauma)
Known gastrointestinal disorder affecting absorption of oral medications
Active uncontrolled infection defined as an identified infectious condition that requires active therapy that has not yet been completed
History of uncontrolled hypertension defined as a sustained systolic blood pressure in excess of 150 mmHg or a sustained diastolic blood pressure in excess of 90 mmHg despite optimized antihypertensive therapy
History of repeated falls and fractures over the past 12 months that in the opinion of the treating investigator would put the patient at risk for poor bone outcomes from androgen receptor targeted therapy
HIV positive patients with CD4 count < 200 cells/microliter within 30 days prior to registration OR HIV patients under treatment with highly active antiretroviral therapy (HAART) within 30 days prior to registration regardless of CD4 count. Note: HIV testing is not required for eligibility for this protocol as it is self-reported. This exclusion criterion is necessary because the treatments involved in this protocol may be immunosuppressive and/or interact with HAART
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