PROMPTS Trial: Screening spinal magnetic resonance imaging in castration-resistant prostate cancer.

Abstract

SUMMARY The PROMPTS trial [1] is a recently concluded phase 3 trial which was conducted in 45 NHS hospitals in the United Kingdom. It evaluated the role of screening spinal magnetic resonance imaging (MRI) and subsequent treatment of radiological spinal cord compression in asymptomatic patients with metastatic castration-resistant prostate cancer (CRPC) and whether early treatment reduced the incidence of clinical spinal cord compression. This study included patients with an Eastern Cooperative Oncology Group performance status of 0–2, with asymptomatic spinal metastasis without any history of prior spinal cord compression, and no spinal MRI in the past 12 months. Patients were randomized 1:1 into two groups. In one group, screening spinal MRI was done followed by treatment for radiological spinal cord compression (if diagnosed). The other group did not undergo the screening spinal MRI. Patients who were included in the study and had screening detected radiological spinal cord compression were offered treatment in the form of radiotherapy or surgical decompression as recommended by the physician and 6-month spinal MRI was done. All patients were followed up every 3 months, and then at the 30 th and 36 th months. The study evaluated the incidence of confirmed clinical spinal cord compression and the time taken to develop cord compression. The trial enrolled 420 patients, 210 in each arm. Screening MRI detected radiological cord compression in 61 (31%) of 200 patients with assessable scans in the intervention group. At a median follow-up of 22 months (interquartile range: 13–31), time to clinical cord compression was not significantly improved with screening. One-year clinical cord compression rates were 6·7% for the control group and 4·3% for the screening and treatment group. Median time to clinical cord compression was not reached in either group. This study concluded that despite there being a significant incidence of radiological (asymptomatic