Blowing our TRoMbone

The UK feasibility randomised trial Testing Radical prostatectomy in men with prostate cancer and oligoMetastases to the bone (TRoMbone) has opened at Oxford University Hospitals (Freddie Hamdy), University College London Hospitals (John Kelly) and Royal Surrey County Hospital (Chris Eden). Men <75 with newly-diagnosed prostate cancer and 1-3 skeletal lesions on any standard-of-care imaging (CT, bone scan, MRI, or PET) who are fit for surgery and deemed to be technically operable are eligible. Emerging but lower-quality data suggests a role for treatment of the primary tumour in men with oligometastatic prostate cancer and this UK study will investigate this question with level 1 evidence.

Participants will be randomly allocated to standard-of-care treatment (hormones +/- chemotherapy) versus standard-of-care treatment plus surgery to remove the prostate and draining lymph nodes (radical prostatectomy plus extended pelvic lymphadenectomy). A qualitative recruitment investigation to optimise accrual will be conducted by the University of Bristol (Caroline Wilson) and biologic samples will be collected, processed and stored in a repository at the Institute of Cancer Research (Gerhardt Attard).

We will assess technical feasibility, safety and complications of surgery in oligometastatic prostate cancer, and examine ways to improve recruitment in this pilot study. TRoMbone is managed by the Surgical Intervention Trials Unit at the University of Oxford and funded by the Prostate Cancer Foundation and The Urology Foundation.

We need to recruit 50 men over a 12-month period, and are seeking referrals from other centres to increase accrual. Centres that demonstrate ability to refer eligible patients will be able to take part in the main trial if we can demonstrate feasibility in this phase and get funding for the larger study.

So please look out for these patients and send them to me at UCLH, Freddie in Oxford, or Chris in Guildford. One of the three of us will do the surgery if they get randomised to it, but of course you are welcome to come with the patients.

If you have any queries please contact me, the study CI (P.Sooriakumaran; prasanna.sooriakumaran@nds.ox.ac.uk) or the study co-ordinator (Neelam Hassanali; trombone@nds.ox.ac.uk). You can start them on androgen deprivation and ‘stop the clock’ before you refer them to us. The extra burden of participating in this study is minimal. They will require one visit for consent, and one follow-up visit at 3 months after randomisation. The surgical group will also have two other visits for their surgery and catheter removal. The rest of the follow-up can be done back at your referring centre or with us, whatever you and the patient prefer. If it is your standard policy to give them chemotherapy or metastasis-directed therapy with SBRT then you can still do that as part of the study.

With your help we can demonstrate that this study is feasible in the UK and we can lead the way in the surgical management of oligometastatic prostate cancer.

What are your thoughts on this pilot and the larger trial we hope to carry out? Share them with us below.

Prasanna Sooriakumaran
Consultant Urological Surgeon, University College Hospital, London

You can also read the news story on the TRoMbone trial here

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