Clinical Trials in Prostate Cancer Care:


Current Opportunities in Southern California

A Comprehensive Overview for IPCSG Members

February 2026

Introduction

Southern California continues to serve as a major hub for innovative prostate cancer clinical research, with numerous trials currently recruiting patients across the spectrum of disease stages—from newly diagnosed localized disease to advanced metastatic castration-resistant prostate cancer (mCRPC). This article provides a comprehensive overview of active clinical trials available to patients in our region, focusing on trials at major academic medical centers and cancer research institutions including UC San Diego (UCSD) Moores Cancer Center, UCLA Jonsson Comprehensive Cancer Center, USC Norris Comprehensive Cancer Center, City of Hope, and Scripps.

For men with prostate cancer and their families, clinical trials represent both an opportunity to access cutting-edge therapies before they become widely available and a chance to contribute to medical knowledge that may benefit future patients. Understanding the landscape of available trials is essential for making informed treatment decisions.

Breakthrough Trials in Advanced and Metastatic Disease

Actinium-225 PSMA-Targeted Alpha Radioligand Therapy

The most exciting development in Southern California prostate cancer research is the emergence of multiple trials investigating actinium-225 (Ac-225) based therapies. Ac-225 emits alpha particles rather than the beta particles emitted by lutetium-177 (used in Pluvicto), delivering significantly more potent radiation over a shorter distance—potentially increasing tumor cell kill while minimizing damage to surrounding tissues.

CONVERGE-01 Trial (NCT06549465): This multicenter Phase II trial is evaluating Ac-225 rosopatamab tetraxetan (CONV01-α) in patients with PSMA PET-positive metastatic castration-resistant prostate cancer. Led by Duke University with principal investigator Dr. Daniel J. George, the trial includes multiple sites nationally, and recruitment began in August 2024 with the first patient dosed in September 2024.

The study has three parts:

  • Part 1: Initial dosimetry evaluation using Indium-111-rosopatamab tetraxetan to characterize biodistribution to target organs and prostate cancer lesions
  • Part 2 (Dose Optimization): For patients who have NOT previously received Lu-177-PSMA radioligand therapy, randomizing to different Ac-225 dose levels (45 or 60 kBq/kg) delivered in a fractionated two-week cycle
  • Part 3 (Dose Escalation): For patients who HAVE progressed after Lu-177-PSMA therapy, evaluating escalating doses (45, 55, or 60 kBq/kg)

This trial is particularly significant because CONV01-α uses a monoclonal antibody platform (rosopatamab) rather than the small molecule ligands used in current PSMA therapies. The antibody approach offers different pharmacokinetics—longer retention in tumors and potentially improved targeting. According to early phase data from Weill Cornell Medicine presented by study co-founder Dr. Neil Bander, CONV01-α demonstrated PSA decline of 50% or greater (PSA50) in 67% of patients and PSA decline of 90% or greater (PSA90) in 27% of patients in preliminary studies.

Importantly, this approach showed minimal salivary gland toxicity—a significant advantage over first-generation Ac-225-PSMA-617 therapies which have been associated with severe xerostomia (dry mouth) in many patients.

City of Hope Actinium-225 Anti-CEA Trial: A Phase Ib trial at City of Hope is evaluating actinium Ac-225-DOTA-M5A anti-CEA antibody in patients with neuroendocrine differentiated prostate cancer. This addresses an important clinical need, as neuroendocrine prostate cancer (NEPC) represents a particularly aggressive variant that often emerges after prolonged androgen receptor pathway inhibition and typically does not respond well to standard PSMA-targeted therapies.

Other Actinium-225 Studies: Multiple retrospective and prospective studies have documented the activity of Ac-225-PSMA-617 in heavily pretreated mCRPC patients. A large multicenter retrospective study (WARMTH Act) published in The Lancet Oncology in 2024 involving 488 patients from seven centers in Australia, India, Germany, and South Africa demonstrated median overall survival of 15.5 months and median progression-free survival of 7.9 months, with PSA decline in 73% of patients and PSA50 response in 57%. These results are particularly impressive given that all patients had received extensive prior therapy including taxane chemotherapy, androgen receptor pathway inhibitors, and many had progressed on Lu-177-PSMA therapy.

Lutetium-177 PSMA Radioligand Therapy Trials

While Pluvicto (Lu-177-PSMA-617) received FDA approval in March 2022 for mCRPC patients who have received prior androgen receptor pathway inhibition and taxane chemotherapy, multiple trials are investigating its use in earlier disease settings and in combination with other agents:

ProstACT GLOBAL Trial (NCT04876651): This multinational Phase III trial is evaluating TLX591 (Lu-177-rosopatamab tetraxetan)—the lutetium-177 version of the same antibody platform used in CONV01-α—in combination with standard of care versus standard of care alone. The trial, which began dosing its first patient in late 2023, uses the same antibody-based approach but with a beta-emitting radionuclide rather than alpha-emitting Ac-225. This trial is recruiting at multiple international sites.

Lutetium-177 PSMA Combination Studies: UCSD Moores Cancer Center and other Southern California sites are participating in trials examining Lu-177-PSMA-617 combined with novel agents including PARP inhibitors, androgen receptor pathway inhibitors, and immunotherapy approaches.

Novel Androgen Receptor Targeting Agents

AR Degrader Trials: Several trials in Southern California are evaluating next-generation compounds that don't just block the androgen receptor (AR) but actually cause its degradation, potentially overcoming resistance mechanisms that limit current AR inhibitors like enzalutamide and abiraterone.

One such trial is evaluating ARX517 at UCSD, a Phase I study assessing safety and tolerability as monotherapy or in combination in patients with metastatic prostate cancer.

Opevesostat Trials: UCSD and UCLA are participating in trials evaluating opevesostat, a lysine-specific demethylase 1 (LSD1) inhibitor, both as monotherapy and in combination with abiraterone or enzalutamide in patients with AR ligand binding domain (AR LBD) mutations—a known resistance mechanism to standard AR pathway inhibitors.

Trials for DNA Repair Deficient Prostate Cancer

Approximately 20-25% of metastatic prostate cancer patients harbor mutations in DNA damage repair genes (BRCA1, BRCA2, ATM, PALB2, and others). Several Southern California trials target this molecularly defined population:

PARP Inhibitor Combination Trials:

  • Olaparib + Radium-223: A Phase I/II trial at UCSD is combining the PARP inhibitor olaparib with radium-223 dichloride in patients with bone metastatic CRPC. This combination capitalizes on synthetic lethality—radium-223 induces DNA damage in bone metastases while olaparib prevents repair of that damage.

  • Olaparib + Cediranib: A randomized Phase II trial is evaluating whether adding cediranib (a VEGF pathway inhibitor) to olaparib improves outcomes compared to olaparib alone in CRPC patients.

  • Neoadjuvant Olaparib: UCSD is conducting a Phase II trial of olaparib plus LHRH agonist administered for 6 months before radical prostatectomy in men with high-risk localized prostate cancer who have confirmed germline or somatic HRR alterations. This represents an attempt to use precision medicine approaches in the curative setting.

Talazoparib Studies: Trials are examining this more potent PARP inhibitor in hormone-sensitive prostate cancer settings, testing whether PARP inhibition earlier in the disease course can improve outcomes for men with DNA repair deficiencies.

Immunotherapy and Combination Approaches

CAR-T Cell Therapy: City of Hope, a leader in CAR-T cell therapy development, is conducting a Phase Ib trial of PSCA-targeting CAR-T cells for PSCA-positive tumors. PSCA (prostate stem cell antigen) is expressed on prostate cancer cells and represents an alternative target to PSMA. The trial is evaluating both safety (adverse events) and efficacy (PSA50 response, overall survival, progression-free survival) of this cellular therapy approach.

Checkpoint Inhibitor Combinations: While single-agent checkpoint inhibitors have shown limited activity in most prostate cancers, multiple Southern California trials are testing combinations:

  • Cabozantinib + Nivolumab: UCSD is conducting a Phase II trial of this combination in advanced CRPC. Cabozantinib, a multi-targeted tyrosine kinase inhibitor, may help overcome the immunologically "cold" tumor microenvironment that limits checkpoint inhibitor activity in prostate cancer.

  • Pembrolizumab in MSI-High/dMMR Prostate Cancer: A study at UCLA/VA is evaluating pembrolizumab in Veterans with mCRPC characterized by mismatch repair deficiency or high microsatellite instability—the subset of prostate cancers most likely to respond to checkpoint inhibition.

Vudalimab (XmAb20717): A Phase II trial at UCSD is evaluating this bispecific antibody targeting PD-1 and CTLA-4 in selected genitourinary malignancies including prostate cancer, offering simultaneous blockade of two immune checkpoints with a single agent.

Novel Mechanism Trials

Cirmtuzumab + Docetaxel: City of Hope is investigating cirmtuzumab (an antibody targeting ROR1, a receptor involved in cancer cell survival and metastasis) in combination with docetaxel chemotherapy for CRPC.

Ifinatamab Deruxtecan (I-DXd, MK-2400): UCLA is participating in a trial of this B7-H3-directed antibody-drug conjugate in mCRPC, representing a novel targeting approach beyond PSMA.

Trials for Localized and Biochemically Recurrent Disease

Active Surveillance and Focal Therapy

Focal Cryoablation: UCSD is conducting a prospective data collection study of men undergoing prostate hemi-gland cryoablation. Unlike whole-gland treatment, focal therapy treats only the cancerous region identified on multiparametric MRI with fusion-targeted biopsy, potentially preserving sexual and urinary function.

MRI-Based Precision Radiation: UCSD is conducting a Phase II randomized trial of image-guided, tumor-focused radiotherapy versus standard whole-prostate treatment in patients with intermediate- or high-risk disease. The hypothesis is that precise tumor targeting will reduce radiation dose to nearby organs (rectum, bladder, urethra) and decrease acute toxicity while maintaining cancer control.

Advanced Imaging Studies

Restriction Spectrum Imaging (RSI) MRI: UCSD is evaluating this advanced diffusion MRI technique for prostate cancer detection and monitoring. The trial is assessing whether multicompartment diffusion models can more reliably identify clinically significant prostate cancer (Grade Group ≥2) compared to standard apparent diffusion coefficient (ADC) measurements.

99mTc-PSMA-I&S Radio-Guided Surgery: UCLA is evaluating PSMA-imaging and surgery (I&S) labeled with Technetium-99m to guide surgical removal of PSMA-expressing lymph nodes in patients undergoing pelvic lymph node dissection. This represents an attempt to use molecular imaging to improve the precision of cancer staging and surgical treatment.

Hyperpolarized 13C Pyruvate MRI: UCLA is studying metabolic imaging with hyperpolarized carbon-13 pyruvate, which may help distinguish high-grade from low-grade prostate cancer and benign tissue based on metabolic differences rather than structural changes alone.

64Cu-SAR-bisPSMA PET/CT: A UCLA study is investigating this copper-64 labeled PSMA PET tracer's ability to detect prostate cancer recurrence, offering an alternative to Ga-68 and F-18 labeled PSMA tracers.

Radiation Therapy Optimization

Stereotactic Body Radiation Therapy (SBRT) with Neurovascular Sparing: UCLA is conducting a trial to determine the optimal technique for protecting neurovascular bundles essential for erectile function during SBRT. The study compares MRI-guided versus CT-guided SBRT delivery with explicit attention to these critical structures.

Apalutamide + SBRT (HEATWAVE Trial): This trial combines apalutamide (a potent androgen receptor inhibitor) with SBRT to the primary tumor. The concept is that androgen deprivation may sensitize tumors to radiation while focal high-dose radiation may reduce tumor burden and potentially delay or prevent metastatic progression.

Trials for Node-Positive Disease After Surgery

NRG-GU008 INNOVATE Trial: USC Norris Comprehensive Cancer Center is participating in this Phase III trial randomizing patients with lymph node-positive (pN+) disease and detectable PSA after radical prostatectomy to 24 months of ADT plus 7 weeks of external beam radiation therapy versus ADT plus apalutamide with/without external beam radiation. This addresses the important question of optimal management for men found to have lymph node involvement at surgery.

Trials for Oligometastatic Disease

The concept of oligometastatic prostate cancer—limited metastatic disease that may be amenable to aggressive local therapy—has gained significant traction. Several Southern California trials are testing this hypothesis:

Metastasis-Directed Therapy Trials: Studies at USC, UCLA, and UCSD are examining whether stereotactic body radiation therapy (SBRT) directed to visible metastases, combined with systemic therapy, can delay disease progression compared to systemic therapy alone. The hypothesis is that eliminating visible disease may reduce tumor burden and potentially defer the need for treatment intensification.

Cytoreductive Prostatectomy Trials: Trials similar to SWOG 1802 and the SIMCAP trial are randomizing patients with oligometastatic disease to best systemic therapy alone versus systemic therapy followed by radical prostatectomy with extended pelvic lymph node dissection. The primary question is whether removing the primary tumor improves failure-free survival in men who already have distant disease.

Trials Addressing Treatment Sequencing and Combinations in mHSPC

For men with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the treatment landscape has evolved dramatically with multiple trials demonstrating survival benefit from early treatment intensification:

High-Dose Testosterone + Enzalutamide: UCSD is conducting a trial in asymptomatic mCRPC patients progressing after ADT plus abiraterone, randomizing to sequential high-dose testosterone followed by enzalutamide versus continuous enzalutamide. This tests the bipolar androgen therapy concept—that cycling between very low and very high androgen levels may overcome resistance.

IRONMAN Registry: UCSD and other international sites are establishing this prospective registry of at least 5,000 men with advanced prostate cancer (mHSPC and M0/M1 CRPC) to better understand variation in care and treatment outcomes across countries and practice settings. Registry studies like this provide real-world data that complement controlled clinical trials.

Integrative and Supportive Care Trials

White Button Mushroom Extract Study: A trial examining whether white button mushroom extract (Agaricus bisporus) taken orally daily for 48 weeks can improve outcomes compared to observation represents the type of integrative oncology research being conducted in Southern California.

How to Access Clinical Trials in Southern California

Patients interested in clinical trial participation should:

  1. Discuss with Your Oncologist: Your treating physician can help determine which trials might be appropriate based on your specific disease characteristics, prior treatments, performance status, and molecular profile.

  2. Contact Major Cancer Centers Directly:

  3. Search ClinicalTrials.gov: This comprehensive federal database allows searching by location, disease stage, and treatment type: https://clinicaltrials.gov

  4. Attend Patient Education Events: UCSD Moores Cancer Center hosts an annual Prostate Cancer Patient Summit (next event: January 30-31, 2026, at UC San Diego Park & Market) bringing together patients, caregivers, and researchers to discuss the latest advances.

Important Considerations for Trial Participation

Eligibility Criteria: Clinical trials have specific inclusion and exclusion criteria. Factors affecting eligibility include:

  • Disease extent and stage
  • Prior treatments received
  • Performance status (ability to carry out daily activities)
  • Laboratory values (kidney function, blood counts, liver function)
  • Presence of specific molecular alterations (for precision medicine trials)
  • PSMA expression on PET imaging (for PSMA-targeted trials)

Understanding Trial Phases:

  • Phase I trials primarily assess safety and dosing; they often enroll patients with advanced disease who have exhausted standard options
  • Phase II trials provide initial efficacy data in selected patient populations
  • Phase III trials compare new treatments to current standard of care and form the basis for FDA approval

Insurance Coverage and Financial Considerations: The Affordable Care Act requires most insurance plans to cover routine patient care costs in clinical trials (office visits, labs, scans), though the investigational agent itself is typically provided at no cost by the trial sponsor.

Important for Patients with Limited or No Insurance: Clinical trials can be particularly valuable for patients with limited or no insurance coverage. The investigational drug or treatment is provided at no cost, and many trials also cover the costs of required study-related procedures, imaging, and laboratory tests. Some trials may also provide assistance with travel expenses. This can make cutting-edge therapies accessible to patients who might otherwise be unable to afford treatment. Patients without insurance or with limited coverage should discuss financial aspects directly with the trial coordinator during the screening process.

Time Commitment: Clinical trials typically require more frequent visits and monitoring than standard care, which should be factored into decision-making, especially for patients traveling from outside the immediate area.

Informed Consent: The informed consent process ensures you understand the trial's purpose, procedures, potential risks and benefits, and alternatives before enrolling. This is not a one-time event—you can ask questions and withdraw from a trial at any time.

Conclusion

Southern California offers prostate cancer patients unprecedented access to innovative clinical research spanning the entire disease spectrum. From next-generation radioligand therapies using alpha-emitting isotopes to precision medicine approaches based on molecular profiling, from focal therapies preserving quality of life to cellular immunotherapies, the trials available in our region represent the cutting edge of prostate cancer treatment.

The CONVERGE-01 trial and other Ac-225-based approaches may represent a paradigm shift in PSMA-targeted therapy, offering more potent tumor cell killing with potentially reduced toxicity compared to current beta-emitting radioligands. The antibody-based platform used in these therapies offers different pharmacology that may prove advantageous.

For IPCSG members, the decision to participate in a clinical trial is deeply personal and should be made in close consultation with your healthcare team, taking into account your individual disease characteristics, treatment history, personal values, and quality of life priorities. However, for many patients—particularly those with advanced disease, those whose cancers harbor specific molecular alterations, or those seeking the most advanced available therapies—clinical trials may offer the best available treatment option and a meaningful opportunity to contribute to the advancement of prostate cancer care.

As our understanding of prostate cancer biology continues to evolve at the molecular level, and as new therapeutic modalities emerge from basic science research, clinical trials will remain the essential bridge translating scientific discoveries into improved patient outcomes.


Sources and References

  1. Convergent Therapeutics Inc. "Convergent Therapeutics Announces First Patient Treated in Phase II Clinical Trial with Lead Therapeutic Candidate and Corporate Updates." PR Newswire, September 24, 2024. https://www.prnewswire.com/news-releases/convergent-therapeutics-announces-first-patient-treated-in-phase-ii-clinical-trial-with-lead-therapeutic-candidate-and-corporate-updates-302256398.html

  2. Convergent Therapeutics Inc. "Convergent Therapeutics Announces Two Clinical Trial Updates on CONV01-α at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium 2025." PR Newswire, February 10, 2025. https://www.prnewswire.com/news-releases/convergent-therapeutics-announces-two-clinical-trial-updates-on-conv01--at-the-american-society-of-clinical-oncology-asco-genitourinary-cancers-symposium-2025-302372722.html

  3. Ponce Kiess A, Nordquist L, Gupta S, et al. "CONVERGE-01: Dosimetry, randomized dose optimization, dose escalation, and efficacy of ac-225 rosopatamab tetraxetan in participants with PSMA-positive castration-resistant prostate cancer." Journal of Clinical Oncology 2025; 43:5_suppl, TPS289. https://ascopubs.org/doi/abs/10.1200/JCO.2025.43.5_suppl.TPS289

  4. ClinicalTrials.gov. "A Phase 2, Open-label Study Evaluating Dosimetry, Randomized Dose Optimization, Dose Escalation and Efficacy of Ac-225 Rosopatamab Tetraxetan in Participants with PSMA PET-Positive Castration-Resistant Prostate Cancer." NCT06549465. https://clinicaltrials.gov/study/NCT06549465

  5. Sathekge MM, Bruchertseifer F, Vorster M, et al. "Actinium-225-PSMA radioligand therapy of metastatic castration-resistant prostate cancer (WARMTH Act): a multicentre, retrospective study." The Lancet Oncology 2024; 25(2):175-183. https://doi.org/10.1016/S1470-2045(23)00638-1

  6. Privé BM, Buteau JP, Nieuwenhuijzen JA, et al. "Time for action: actinium-225 PSMA-targeted alpha therapy for metastatic prostate cancer - a systematic review and meta-analysis." Theranostics 2025; 15(4):1363-1382. https://pubmed.ncbi.nlm.nih.gov/40093902/

  7. Kratochwil C, Bruchertseifer F, Giesel FL, et al. "225Ac-PSMA-617 for PSMA-Targeted α-Radiation Therapy of Metastatic Castration-Resistant Prostate Cancer." Journal of Nuclear Medicine 2016; 57(12):1941-1944. https://doi.org/10.2967/jnumed.116.178673

  8. Sathekge M, Bruchertseifer F, Knoesen O, et al. "225Ac-PSMA-617 in chemotherapy-naive patients with advanced prostate cancer: a pilot study." European Journal of Nuclear Medicine and Molecular Imaging 2019; 46(1):129-138. https://pubmed.ncbi.nlm.nih.gov/30232539/

  9. Sartor O, de Bono J, Chi KN, et al. "Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer." New England Journal of Medicine 2021; 385(12):1091-1103. https://doi.org/10.1056/NEJMoa2107322

  10. Morris MJ, Castellano D, Herrmann K, et al. "177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial." The Lancet 2024; 404:1227-1239. https://doi.org/10.1016/S0140-6736(24)01645-3

  11. de Bono J, Mateo J, Fizazi K, et al. "Olaparib for Metastatic Castration-Resistant Prostate Cancer." New England Journal of Medicine 2020; 382(22):2091-2102. https://doi.org/10.1056/NEJMoa1911440

  12. University of California San Diego Health. "Prostate Cancer Clinical Trials." UCSD Moores Cancer Center. https://clinicaltrials.ucsd.edu/prostate-cancer

  13. UCLA Jonsson Comprehensive Cancer Center. "Prostate Cancer Research and Clinical Trials." https://ucla.clinicaltrials.researcherprofiles.org/prostate-cancer

  14. City of Hope. "Prostate Cancer Clinical Trials." https://www.cityofhope.org/clinical-program/prostate-cancer/research

  15. USC Norris Comprehensive Cancer Center. "Clinical Trials in Prostate Cancer." https://uscnorriscancer.usc.edu/clinical-trials

  16. Telix Pharmaceuticals Limited. "First Patient Dosed in Phase III ProstACT GLOBAL Study of Antibody-based Prostate Cancer Therapy Candidate, TLX591." January 10, 2024. https://telixpharma.com/news-views/first-patient-dosed-in-phase-iii-prostact-global-study-of-antibody-based-prostate-cancer-therapy-candidate-tlx591/

  17. Southern California GU Cancer Research Forum. "Prostate Cancer Case Studies: Localized, Salvage Radiotherapy/BCR, mHSPC, and mCRPC." UroToday, 2024. https://www.urotoday.com/conference-highlights/inaugural-southern-california-genitourinary-cancer-research-forum-2024/150196-southern-ca-gu-cancer-research-forum-2024-prostate-cancer-case-studies-localized-salvage-radiotherapy-bcr-mhspc-and-mcrpc.html

  18. National Cancer Institute. "Prostate Cancer Treatment (PDQ®)–Health Professional Version." https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq

  19. UC San Diego Health. "Prostate Cancer Program." Moores Cancer Center. https://health.ucsd.edu/care/cancer/cancers-we-treat/prostate/

  20. UCLA Health. "Prostate Cancer Research." Jonsson Comprehensive Cancer Center. https://www.uclahealth.org/cancer/cancer-services/prostate-cancer/research


This article is intended for educational purposes and should not replace consultation with qualified healthcare providers. Treatment decisions should be made in consultation with your medical team based on your individual circumstances. Clinical trial information is current as of February 2026 and is subject to change. Always verify trial status and eligibility criteria directly with the study sites.

Current Opportunities in Southern California

A Comprehensive Overview for IPCSG Members

February 2026

Introduction

Southern California continues to serve as a major hub for innovative prostate cancer clinical research, with numerous trials currently recruiting patients across the spectrum of disease stages—from newly diagnosed localized disease to advanced metastatic castration-resistant prostate cancer (mCRPC). This article provides a comprehensive overview of active clinical trials available to patients in our region, focusing on trials at major academic medical centers and cancer research institutions including UC San Diego (UCSD) Moores Cancer Center, UCLA Jonsson Comprehensive Cancer Center, USC Norris Comprehensive Cancer Center, City of Hope, and Scripps.

For men with prostate cancer and their families, clinical trials represent both an opportunity to access cutting-edge therapies before they become widely available and a chance to contribute to medical knowledge that may benefit future patients. Understanding the landscape of available trials is essential for making informed treatment decisions.

Breakthrough Trials in Advanced and Metastatic Disease

Actinium-225 PSMA-Targeted Alpha Radioligand Therapy

The most exciting development in Southern California prostate cancer research is the emergence of multiple trials investigating actinium-225 (Ac-225) based therapies. Ac-225 emits alpha particles rather than the beta particles emitted by lutetium-177 (used in Pluvicto), delivering significantly more potent radiation over a shorter distance—potentially increasing tumor cell kill while minimizing damage to surrounding tissues.

CONVERGE-01 Trial (NCT06549465): This multicenter Phase II trial is evaluating Ac-225 rosopatamab tetraxetan (CONV01-α) in patients with PSMA PET-positive metastatic castration-resistant prostate cancer. Led by Duke University with principal investigator Dr. Daniel J. George, the trial includes multiple sites nationally, and recruitment began in August 2024 with the first patient dosed in September 2024.

The study has three parts:

  • Part 1: Initial dosimetry evaluation using Indium-111-rosopatamab tetraxetan to characterize biodistribution to target organs and prostate cancer lesions
  • Part 2 (Dose Optimization): For patients who have NOT previously received Lu-177-PSMA radioligand therapy, randomizing to different Ac-225 dose levels (45 or 60 kBq/kg) delivered in a fractionated two-week cycle
  • Part 3 (Dose Escalation): For patients who HAVE progressed after Lu-177-PSMA therapy, evaluating escalating doses (45, 55, or 60 kBq/kg)

This trial is particularly significant because CONV01-α uses a monoclonal antibody platform (rosopatamab) rather than the small molecule ligands used in current PSMA therapies. The antibody approach offers different pharmacokinetics—longer retention in tumors and potentially improved targeting. According to early phase data from Weill Cornell Medicine presented by study co-founder Dr. Neil Bander, CONV01-α demonstrated PSA decline of 50% or greater (PSA50) in 67% of patients and PSA decline of 90% or greater (PSA90) in 27% of patients in preliminary studies.

Importantly, this approach showed minimal salivary gland toxicity—a significant advantage over first-generation Ac-225-PSMA-617 therapies which have been associated with severe xerostomia (dry mouth) in many patients.

City of Hope Actinium-225 Anti-CEA Trial: A Phase Ib trial at City of Hope is evaluating actinium Ac-225-DOTA-M5A anti-CEA antibody in patients with neuroendocrine differentiated prostate cancer. This addresses an important clinical need, as neuroendocrine prostate cancer (NEPC) represents a particularly aggressive variant that often emerges after prolonged androgen receptor pathway inhibition and typically does not respond well to standard PSMA-targeted therapies.

Other Actinium-225 Studies: Multiple retrospective and prospective studies have documented the activity of Ac-225-PSMA-617 in heavily pretreated mCRPC patients. A large multicenter retrospective study (WARMTH Act) published in The Lancet Oncology in 2024 involving 488 patients from seven centers in Australia, India, Germany, and South Africa demonstrated median overall survival of 15.5 months and median progression-free survival of 7.9 months, with PSA decline in 73% of patients and PSA50 response in 57%. These results are particularly impressive given that all patients had received extensive prior therapy including taxane chemotherapy, androgen receptor pathway inhibitors, and many had progressed on Lu-177-PSMA therapy.

Lutetium-177 PSMA Radioligand Therapy Trials

While Pluvicto (Lu-177-PSMA-617) received FDA approval in March 2022 for mCRPC patients who have received prior androgen receptor pathway inhibition and taxane chemotherapy, multiple trials are investigating its use in earlier disease settings and in combination with other agents:

ProstACT GLOBAL Trial (NCT04876651): This multinational Phase III trial is evaluating TLX591 (Lu-177-rosopatamab tetraxetan)—the lutetium-177 version of the same antibody platform used in CONV01-α—in combination with standard of care versus standard of care alone. The trial, which began dosing its first patient in late 2023, uses the same antibody-based approach but with a beta-emitting radionuclide rather than alpha-emitting Ac-225. This trial is recruiting at multiple international sites.

Lutetium-177 PSMA Combination Studies: UCSD Moores Cancer Center and other Southern California sites are participating in trials examining Lu-177-PSMA-617 combined with novel agents including PARP inhibitors, androgen receptor pathway inhibitors, and immunotherapy approaches.

Novel Androgen Receptor Targeting Agents

AR Degrader Trials: Several trials in Southern California are evaluating next-generation compounds that don't just block the androgen receptor (AR) but actually cause its degradation, potentially overcoming resistance mechanisms that limit current AR inhibitors like enzalutamide and abiraterone.

One such trial is evaluating ARX517 at UCSD, a Phase I study assessing safety and tolerability as monotherapy or in combination in patients with metastatic prostate cancer.

Opevesostat Trials: UCSD and UCLA are participating in trials evaluating opevesostat, a lysine-specific demethylase 1 (LSD1) inhibitor, both as monotherapy and in combination with abiraterone or enzalutamide in patients with AR ligand binding domain (AR LBD) mutations—a known resistance mechanism to standard AR pathway inhibitors.

Trials for DNA Repair Deficient Prostate Cancer

Approximately 20-25% of metastatic prostate cancer patients harbor mutations in DNA damage repair genes (BRCA1, BRCA2, ATM, PALB2, and others). Several Southern California trials target this molecularly defined population:

PARP Inhibitor Combination Trials:

  • Olaparib + Radium-223: A Phase I/II trial at UCSD is combining the PARP inhibitor olaparib with radium-223 dichloride in patients with bone metastatic CRPC. This combination capitalizes on synthetic lethality—radium-223 induces DNA damage in bone metastases while olaparib prevents repair of that damage.

  • Olaparib + Cediranib: A randomized Phase II trial is evaluating whether adding cediranib (a VEGF pathway inhibitor) to olaparib improves outcomes compared to olaparib alone in CRPC patients.

  • Neoadjuvant Olaparib: UCSD is conducting a Phase II trial of olaparib plus LHRH agonist administered for 6 months before radical prostatectomy in men with high-risk localized prostate cancer who have confirmed germline or somatic HRR alterations. This represents an attempt to use precision medicine approaches in the curative setting.

Talazoparib Studies: Trials are examining this more potent PARP inhibitor in hormone-sensitive prostate cancer settings, testing whether PARP inhibition earlier in the disease course can improve outcomes for men with DNA repair deficiencies.

Immunotherapy and Combination Approaches

CAR-T Cell Therapy: City of Hope, a leader in CAR-T cell therapy development, is conducting a Phase Ib trial of PSCA-targeting CAR-T cells for PSCA-positive tumors. PSCA (prostate stem cell antigen) is expressed on prostate cancer cells and represents an alternative target to PSMA. The trial is evaluating both safety (adverse events) and efficacy (PSA50 response, overall survival, progression-free survival) of this cellular therapy approach.

Checkpoint Inhibitor Combinations: While single-agent checkpoint inhibitors have shown limited activity in most prostate cancers, multiple Southern California trials are testing combinations:

  • Cabozantinib + Nivolumab: UCSD is conducting a Phase II trial of this combination in advanced CRPC. Cabozantinib, a multi-targeted tyrosine kinase inhibitor, may help overcome the immunologically "cold" tumor microenvironment that limits checkpoint inhibitor activity in prostate cancer.

  • Pembrolizumab in MSI-High/dMMR Prostate Cancer: A study at UCLA/VA is evaluating pembrolizumab in Veterans with mCRPC characterized by mismatch repair deficiency or high microsatellite instability—the subset of prostate cancers most likely to respond to checkpoint inhibition.

Vudalimab (XmAb20717): A Phase II trial at UCSD is evaluating this bispecific antibody targeting PD-1 and CTLA-4 in selected genitourinary malignancies including prostate cancer, offering simultaneous blockade of two immune checkpoints with a single agent.

Novel Mechanism Trials

Cirmtuzumab + Docetaxel: City of Hope is investigating cirmtuzumab (an antibody targeting ROR1, a receptor involved in cancer cell survival and metastasis) in combination with docetaxel chemotherapy for CRPC.

Ifinatamab Deruxtecan (I-DXd, MK-2400): UCLA is participating in a trial of this B7-H3-directed antibody-drug conjugate in mCRPC, representing a novel targeting approach beyond PSMA.

Trials for Localized and Biochemically Recurrent Disease

Active Surveillance and Focal Therapy

Focal Cryoablation: UCSD is conducting a prospective data collection study of men undergoing prostate hemi-gland cryoablation. Unlike whole-gland treatment, focal therapy treats only the cancerous region identified on multiparametric MRI with fusion-targeted biopsy, potentially preserving sexual and urinary function.

MRI-Based Precision Radiation: UCSD is conducting a Phase II randomized trial of image-guided, tumor-focused radiotherapy versus standard whole-prostate treatment in patients with intermediate- or high-risk disease. The hypothesis is that precise tumor targeting will reduce radiation dose to nearby organs (rectum, bladder, urethra) and decrease acute toxicity while maintaining cancer control.

Advanced Imaging Studies

Restriction Spectrum Imaging (RSI) MRI: UCSD is evaluating this advanced diffusion MRI technique for prostate cancer detection and monitoring. The trial is assessing whether multicompartment diffusion models can more reliably identify clinically significant prostate cancer (Grade Group ≥2) compared to standard apparent diffusion coefficient (ADC) measurements.

99mTc-PSMA-I&S Radio-Guided Surgery: UCLA is evaluating PSMA-imaging and surgery (I&S) labeled with Technetium-99m to guide surgical removal of PSMA-expressing lymph nodes in patients undergoing pelvic lymph node dissection. This represents an attempt to use molecular imaging to improve the precision of cancer staging and surgical treatment.

Hyperpolarized 13C Pyruvate MRI: UCLA is studying metabolic imaging with hyperpolarized carbon-13 pyruvate, which may help distinguish high-grade from low-grade prostate cancer and benign tissue based on metabolic differences rather than structural changes alone.

64Cu-SAR-bisPSMA PET/CT: A UCLA study is investigating this copper-64 labeled PSMA PET tracer's ability to detect prostate cancer recurrence, offering an alternative to Ga-68 and F-18 labeled PSMA tracers.

Radiation Therapy Optimization

Stereotactic Body Radiation Therapy (SBRT) with Neurovascular Sparing: UCLA is conducting a trial to determine the optimal technique for protecting neurovascular bundles essential for erectile function during SBRT. The study compares MRI-guided versus CT-guided SBRT delivery with explicit attention to these critical structures.

Apalutamide + SBRT (HEATWAVE Trial): This trial combines apalutamide (a potent androgen receptor inhibitor) with SBRT to the primary tumor. The concept is that androgen deprivation may sensitize tumors to radiation while focal high-dose radiation may reduce tumor burden and potentially delay or prevent metastatic progression.

Trials for Node-Positive Disease After Surgery

NRG-GU008 INNOVATE Trial: USC Norris Comprehensive Cancer Center is participating in this Phase III trial randomizing patients with lymph node-positive (pN+) disease and detectable PSA after radical prostatectomy to 24 months of ADT plus 7 weeks of external beam radiation therapy versus ADT plus apalutamide with/without external beam radiation. This addresses the important question of optimal management for men found to have lymph node involvement at surgery.

Trials for Oligometastatic Disease

The concept of oligometastatic prostate cancer—limited metastatic disease that may be amenable to aggressive local therapy—has gained significant traction. Several Southern California trials are testing this hypothesis:

Metastasis-Directed Therapy Trials: Studies at USC, UCLA, and UCSD are examining whether stereotactic body radiation therapy (SBRT) directed to visible metastases, combined with systemic therapy, can delay disease progression compared to systemic therapy alone. The hypothesis is that eliminating visible disease may reduce tumor burden and potentially defer the need for treatment intensification.

Cytoreductive Prostatectomy Trials: Trials similar to SWOG 1802 and the SIMCAP trial are randomizing patients with oligometastatic disease to best systemic therapy alone versus systemic therapy followed by radical prostatectomy with extended pelvic lymph node dissection. The primary question is whether removing the primary tumor improves failure-free survival in men who already have distant disease.

Trials Addressing Treatment Sequencing and Combinations in mHSPC

For men with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the treatment landscape has evolved dramatically with multiple trials demonstrating survival benefit from early treatment intensification:

High-Dose Testosterone + Enzalutamide: UCSD is conducting a trial in asymptomatic mCRPC patients progressing after ADT plus abiraterone, randomizing to sequential high-dose testosterone followed by enzalutamide versus continuous enzalutamide. This tests the bipolar androgen therapy concept—that cycling between very low and very high androgen levels may overcome resistance.

IRONMAN Registry: UCSD and other international sites are establishing this prospective registry of at least 5,000 men with advanced prostate cancer (mHSPC and M0/M1 CRPC) to better understand variation in care and treatment outcomes across countries and practice settings. Registry studies like this provide real-world data that complement controlled clinical trials.

Integrative and Supportive Care Trials

White Button Mushroom Extract Study: A trial examining whether white button mushroom extract (Agaricus bisporus) taken orally daily for 48 weeks can improve outcomes compared to observation represents the type of integrative oncology research being conducted in Southern California.

How to Access Clinical Trials in Southern California

Patients interested in clinical trial participation should:

  1. Discuss with Your Oncologist: Your treating physician can help determine which trials might be appropriate based on your specific disease characteristics, prior treatments, performance status, and molecular profile.

  2. Contact Major Cancer Centers Directly:

  3. Search ClinicalTrials.gov: This comprehensive federal database allows searching by location, disease stage, and treatment type: https://clinicaltrials.gov

  4. Attend Patient Education Events: UCSD Moores Cancer Center hosts an annual Prostate Cancer Patient Summit (next event: January 30-31, 2026, at UC San Diego Park & Market) bringing together patients, caregivers, and researchers to discuss the latest advances.

Important Considerations for Trial Participation

Eligibility Criteria: Clinical trials have specific inclusion and exclusion criteria. Factors affecting eligibility include:

  • Disease extent and stage
  • Prior treatments received
  • Performance status (ability to carry out daily activities)
  • Laboratory values (kidney function, blood counts, liver function)
  • Presence of specific molecular alterations (for precision medicine trials)
  • PSMA expression on PET imaging (for PSMA-targeted trials)

Understanding Trial Phases:

  • Phase I trials primarily assess safety and dosing; they often enroll patients with advanced disease who have exhausted standard options
  • Phase II trials provide initial efficacy data in selected patient populations
  • Phase III trials compare new treatments to current standard of care and form the basis for FDA approval

Insurance Coverage: The Affordable Care Act requires most insurance plans to cover routine patient care costs in clinical trials (office visits, labs, scans), though the investigational agent itself is typically provided at no cost by the trial sponsor.

Time Commitment: Clinical trials typically require more frequent visits and monitoring than standard care, which should be factored into decision-making, especially for patients traveling from outside the immediate area.

Informed Consent: The informed consent process ensures you understand the trial's purpose, procedures, potential risks and benefits, and alternatives before enrolling. This is not a one-time event—you can ask questions and withdraw from a trial at any time.

Conclusion

Southern California offers prostate cancer patients unprecedented access to innovative clinical research spanning the entire disease spectrum. From next-generation radioligand therapies using alpha-emitting isotopes to precision medicine approaches based on molecular profiling, from focal therapies preserving quality of life to cellular immunotherapies, the trials available in our region represent the cutting edge of prostate cancer treatment.

The CONVERGE-01 trial and other Ac-225-based approaches may represent a paradigm shift in PSMA-targeted therapy, offering more potent tumor cell killing with potentially reduced toxicity compared to current beta-emitting radioligands. The antibody-based platform used in these therapies offers different pharmacology that may prove advantageous.

For IPCSG members, the decision to participate in a clinical trial is deeply personal and should be made in close consultation with your healthcare team, taking into account your individual disease characteristics, treatment history, personal values, and quality of life priorities. However, for many patients—particularly those with advanced disease, those whose cancers harbor specific molecular alterations, or those seeking the most advanced available therapies—clinical trials may offer the best available treatment option and a meaningful opportunity to contribute to the advancement of prostate cancer care.

As our understanding of prostate cancer biology continues to evolve at the molecular level, and as new therapeutic modalities emerge from basic science research, clinical trials will remain the essential bridge translating scientific discoveries into improved patient outcomes.


Sources and References

  1. Convergent Therapeutics Inc. "Convergent Therapeutics Announces First Patient Treated in Phase II Clinical Trial with Lead Therapeutic Candidate and Corporate Updates." PR Newswire, September 24, 2024. https://www.prnewswire.com/news-releases/convergent-therapeutics-announces-first-patient-treated-in-phase-ii-clinical-trial-with-lead-therapeutic-candidate-and-corporate-updates-302256398.html

  2. Convergent Therapeutics Inc. "Convergent Therapeutics Announces Two Clinical Trial Updates on CONV01-α at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium 2025." PR Newswire, February 10, 2025. https://www.prnewswire.com/news-releases/convergent-therapeutics-announces-two-clinical-trial-updates-on-conv01--at-the-american-society-of-clinical-oncology-asco-genitourinary-cancers-symposium-2025-302372722.html

  3. Ponce Kiess A, Nordquist L, Gupta S, et al. "CONVERGE-01: Dosimetry, randomized dose optimization, dose escalation, and efficacy of ac-225 rosopatamab tetraxetan in participants with PSMA-positive castration-resistant prostate cancer." Journal of Clinical Oncology 2025; 43:5_suppl, TPS289. https://ascopubs.org/doi/abs/10.1200/JCO.2025.43.5_suppl.TPS289

  4. ClinicalTrials.gov. "A Phase 2, Open-label Study Evaluating Dosimetry, Randomized Dose Optimization, Dose Escalation and Efficacy of Ac-225 Rosopatamab Tetraxetan in Participants with PSMA PET-Positive Castration-Resistant Prostate Cancer." NCT06549465. https://clinicaltrials.gov/study/NCT06549465

  5. Sathekge MM, Bruchertseifer F, Vorster M, et al. "Actinium-225-PSMA radioligand therapy of metastatic castration-resistant prostate cancer (WARMTH Act): a multicentre, retrospective study." The Lancet Oncology 2024; 25(2):175-183. https://doi.org/10.1016/S1470-2045(23)00638-1

  6. Privé BM, Buteau JP, Nieuwenhuijzen JA, et al. "Time for action: actinium-225 PSMA-targeted alpha therapy for metastatic prostate cancer - a systematic review and meta-analysis." Theranostics 2025; 15(4):1363-1382. https://pubmed.ncbi.nlm.nih.gov/40093902/

  7. Kratochwil C, Bruchertseifer F, Giesel FL, et al. "225Ac-PSMA-617 for PSMA-Targeted α-Radiation Therapy of Metastatic Castration-Resistant Prostate Cancer." Journal of Nuclear Medicine 2016; 57(12):1941-1944. https://doi.org/10.2967/jnumed.116.178673

  8. Sathekge M, Bruchertseifer F, Knoesen O, et al. "225Ac-PSMA-617 in chemotherapy-naive patients with advanced prostate cancer: a pilot study." European Journal of Nuclear Medicine and Molecular Imaging 2019; 46(1):129-138. https://pubmed.ncbi.nlm.nih.gov/30232539/

  9. Sartor O, de Bono J, Chi KN, et al. "Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer." New England Journal of Medicine 2021; 385(12):1091-1103. https://doi.org/10.1056/NEJMoa2107322

  10. Morris MJ, Castellano D, Herrmann K, et al. "177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial." The Lancet 2024; 404:1227-1239. https://doi.org/10.1016/S0140-6736(24)01645-3

  11. de Bono J, Mateo J, Fizazi K, et al. "Olaparib for Metastatic Castration-Resistant Prostate Cancer." New England Journal of Medicine 2020; 382(22):2091-2102. https://doi.org/10.1056/NEJMoa1911440

  12. University of California San Diego Health. "Prostate Cancer Clinical Trials." UCSD Moores Cancer Center. https://clinicaltrials.ucsd.edu/prostate-cancer

  13. UCLA Jonsson Comprehensive Cancer Center. "Prostate Cancer Research and Clinical Trials." https://ucla.clinicaltrials.researcherprofiles.org/prostate-cancer

  14. City of Hope. "Prostate Cancer Clinical Trials." https://www.cityofhope.org/clinical-program/prostate-cancer/research

  15. USC Norris Comprehensive Cancer Center. "Clinical Trials in Prostate Cancer." https://uscnorriscancer.usc.edu/clinical-trials

  16. Telix Pharmaceuticals Limited. "First Patient Dosed in Phase III ProstACT GLOBAL Study of Antibody-based Prostate Cancer Therapy Candidate, TLX591." January 10, 2024. https://telixpharma.com/news-views/first-patient-dosed-in-phase-iii-prostact-global-study-of-antibody-based-prostate-cancer-therapy-candidate-tlx591/

  17. Southern California GU Cancer Research Forum. "Prostate Cancer Case Studies: Localized, Salvage Radiotherapy/BCR, mHSPC, and mCRPC." UroToday, 2024. https://www.urotoday.com/conference-highlights/inaugural-southern-california-genitourinary-cancer-research-forum-2024/150196-southern-ca-gu-cancer-research-forum-2024-prostate-cancer-case-studies-localized-salvage-radiotherapy-bcr-mhspc-and-mcrpc.html

  18. National Cancer Institute. "Prostate Cancer Treatment (PDQ®)–Health Professional Version." https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq

  19. UC San Diego Health. "Prostate Cancer Program." Moores Cancer Center. https://health.ucsd.edu/care/cancer/cancers-we-treat/prostate/

  20. UCLA Health. "Prostate Cancer Research." Jonsson Comprehensive Cancer Center. https://www.uclahealth.org/cancer/cancer-services/prostate-cancer/research


This article is intended for educational purposes and should not replace consultation with qualified healthcare providers. Treatment decisions should be made in consultation with your medical team based on your individual circumstances. Clinical trial information is current as of February 2026 and is subject to change. Always verify trial status and eligibility criteria directly with the study sites.

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