# VA STARPORT: HCP commentary report

> 119 verified statements (72 from clinicians verified by NPI or staff page) from 25 commentary sources · 11 findings · updated Oct 29, 2026

## Report

- Trial: Veterans Affairs Seamless Phase II/III Randomized Trial of STAndard Systemic theRapy With or Without PET-directed Local Therapy for OligoRecurrenT Prostate Cancer (VA STARPORT)
- NCT ID: NCT04787744
- Registry: https://clinicaltrials.gov/study/NCT04787744
- Sponsor: VA Office of Research and Development
- Phase: Phase 2/Phase 3
- Status: Active, not recruiting
- Drugs tested: none (the trial tests no drug)
- Indication: oligometastatic prostate cancer
- Version: v1.0.0, edition 1
- Accepted: 2026-10-29
- Last checked: 2026-10-29
- Release hash: eded92fb63ec2baa9881259cbc369b83dafe21255694e467932655d1bfd24f00

## Counts

- HCP commentary sources screened: 47
- Sources cited by verified statements: 26
- Verified statements: 119
- From speakers with a confirmed clinical role (verified by the NPI registry or their own institution's staff page): 72
- Findings: 11
- Named people in screened sources (unnamed speakers and accounts not counted): 37
- Voices cited: 36
- Cited voices identity-verified: 33
- Organisational or shared accounts (not counted as people): 1

Counts describe the retained sources. They do not estimate how many HCPs hold a view.

## Abstract

VA STARPORT asks whether adding PET-directed local treatment to systemic therapy delays castration resistance in Veterans with oligometastatic prostate cancer. In an X exchange, a poster challenges the preference for focal rather than elective nodal treatment. An X poster welcomes multicenter VA research, while an X poster questions endpoint interpretation. The incremental benefit of local treatment and the trial’s eventual influence on practice remain unresolved.

## Open Medical Affairs question

How should teams explain uncertain incremental benefit and differing local-treatment choices without implying that one randomized group is already inferior?

Raised by the leading finding. The report shows what clinicians said and the sources behind it; it does not settle the question.

## Findings (titles)

- F1. The unresolved decision is whether local therapy adds to systemic care—not whether it can replace systemic care
- F2. Endpoint credibility is challenged by the possibility that MDT changes PSA without establishing broader disease control
- F3. Focal SBRT versus elective nodal treatment remains disputed, and VA STARPORT does not randomize that choice
- F4. Safety arguments depend on treatment volume and evidence type; focal nodal SBRT is not large-field five-fraction treatment
- F5. The prostate MDT question includes strong biological skepticism, but cross-cancer generalization is contested
- F6. Favorable intermittent-therapy and pooled-MDT interpretations remain distinct from VA STARPORT efficacy
- F7. Imaging and molecular biology are proposed as better selection tools, but neither is established here as a replacement for counting metastases
- F8. Recruitment difficulty is attributed to clinician preferences as well as labor, support and patient-care trade-offs
- F9. Recruitment wording is contested, with family conversations and shared decisions offered as safeguards
- F10. Trial access and multidisciplinary care are valued separately from any eventual MDT treatment effect
- F11. Anticipation is emphatic, but speakers still condition clinical impact on mature results

## What sits behind each finding

Counts describe what the report retained, not how many clinicians hold a view. A statement can support more than one finding.

| Finding | Statements | Passages | Sources | Named voices | Counterview | Limitations |
| --- | ---: | ---: | ---: | ---: | --- | ---: |
| F1 | 20 | 15 | 6 | 8 | recorded | 2 |
| F2 | 7 | 6 | 5 | 4 | recorded | 2 |
| F3 | 14 | 14 | 1 | 6 | recorded | 2 |
| F4 | 9 | 9 | 1 | 5 | recorded | 2 |
| F5 | 18 | 19 | 1 | 12 | recorded | 2 |
| F6 | 13 | 14 | 6 | 5 | recorded | 3 |
| F7 | 11 | 12 | 6 | 8 | recorded | 2 |
| F8 | 14 | 14 | 1 | 7 | recorded | 2 |
| F9 | 14 | 10 | 2 | 3 | recorded | 2 |
| F10 | 8 | 9 | 8 | 4 | none recorded | 2 |
| F11 | 7 | 7 | 2 | 4 | none recorded | 2 |

### What the statements are

| Finding | Views | Questions and uncertainty | Clinical experience | Comparisons | Restated results and context | Passages supporting | Passages giving context | Sources by kind | Feeds the Medical Affairs question |
| --- | ---: | ---: | ---: | ---: | ---: | ---: | ---: | --- | --- |
| F1 | 9 | 6 | 0 | 0 | 5 | 21 | 1 | 4 posts and articles, 1 podcast or video, 1 registry | yes |
| F2 | 2 | 2 | 0 | 0 | 3 | 7 | 0 | 4 posts and articles, 1 registry | yes |
| F3 | 1 | 3 | 2 | 4 | 4 | 14 | 0 | 1 post or article | yes |
| F4 | 4 | 2 | 1 | 0 | 2 | 9 | 0 | 1 post or article | yes |
| F5 | 9 | 2 | 2 | 3 | 2 | 18 | 1 | 1 post or article | yes |
| F6 | 6 | 0 | 0 | 1 | 6 | 14 | 4 | 6 posts and articles | yes |
| F7 | 4 | 4 | 1 | 1 | 1 | 11 | 1 | 5 posts and articles, 1 registry | yes |
| F8 | 7 | 2 | 2 | 1 | 2 | 14 | 0 | 1 post or article | yes |
| F9 | 8 | 1 | 2 | 0 | 3 | 16 | 2 | 1 post or article, 1 podcast or video | yes |
| F10 | 5 | 0 | 3 | 0 | 0 | 8 | 1 | 7 posts and articles, 1 podcast or video | yes |
| F11 | 3 | 2 | 0 | 2 | 0 | 7 | 0 | 2 posts and articles | yes |

### Trial dimensions

- Primary endpoint: Castration-resistant prostate cancer-free survival (CRPC-free survival): F2 (3 shared claims)
- Secondary endpoints: F2 (2 shared claims)
- Population and setting: F1 (1 shared claims), F6 (1 shared claims), F7 (5 shared claims), F9 (1 shared claims), F10 (1 shared claims), F11 (2 shared claims)
- The comparison: F1 (16 shared claims), F3 (2 shared claims), F5 (2 shared claims), F6 (2 shared claims), F9 (5 shared claims)
- Safety and tolerability: F1 (1 shared claims), F3 (1 shared claims), F4 (9 shared claims), F9 (2 shared claims)
- Design and conduct: F1 (4 shared claims), F2 (2 shared claims), F3 (2 shared claims), F6 (1 shared claims), F8 (1 shared claims), F9 (2 shared claims), F10 (1 shared claims), F11 (3 shared claims)

## Sample findings

Paraphrased; the full report links each statement to its source.

### F2. Endpoint credibility is challenged by the possibility that MDT changes PSA without establishing broader disease control

An X-thread post asks which assumptions were used to determine VA STARPORT’s sample size.

Source: X thread.

### F7. Imaging and molecular biology are proposed as better selection tools, but neither is established here as a replacement for counting metastases

In an X thread that names VA STARPORT, a post asks whether molecular markers might replace metastasis counts when selecting treatment.

Source: X thread, 2022-03-29.

## What's inside

| Section | Items | Access |
| --- | ---: | --- |
| Findings with interpretation, counterviews and limits | 11 | Titles free |
| Detailed analysis | 12 sections | Paid |
| Verified statements with short source quotes and links | 119 | Paid |
| Trial aspects mapped | 14 | Free |
| Sources with links | 26 | Counts free |
| Speaker attribution for cited voices | 36 | Paid |

## Trial aspects

14 discussed · 0 no commentary found · 0 assessment incomplete.

| Aspect | Coverage | Statements | Sources |
| --- | --- | ---: | ---: |
| Primary endpoint: Castration-resistant prostate cancer-free survival (CRPC-free survival) | discussed | 3 | 2 |
| Secondary endpoints | discussed | 2 | 1 |
| Population and setting | discussed | 8 | 5 |
| The comparison | discussed | 20 | 6 |
| Safety and tolerability | discussed | 12 | 2 |
| Design and conduct | discussed | 14 | 9 |
| Nodal treatment extent, adjacent recurrence and retreatment | discussed | 14 | 1 |
| PSMA PET, metastatic burden and molecular selection | discussed | 10 | 5 |
| Biological skepticism and cross-cancer extrapolation | discussed | 16 | 1 |
| SATURN, SOLAR, EXTEND, GU011 and WOLVERINE as evidence around the VA STARPORT question | discussed | 11 | 5 |
| Clinician equipoise, recruiter training and recruitment resources | discussed | 14 | 1 |
| Recruitment language, family counseling and shared treatment decisions | discussed | 14 | 2 |
| Veteran access, participating sites and multidisciplinary care | discussed | 8 | 8 |
| Anticipated practice impact, study size and data maturity | discussed | 7 | 2 |

An aspect marked incomplete is a question the public commentary did not let us answer. We show it rather than hide it.

## Sources

| Channel | Screened | Cited |
| --- | ---: | ---: |
| X threads | 46 | 24 |
| YouTube | 1 | 1 |
| Registry (primary source, cited for context) | not screened | 1 |

- Screened window: 2020-11-29 to 2026-10-08
- Cited window: 2020-11-29 to 2026-10-08
- Retrieved: 2026-10-29

Screened sources were retrieved for this trial. Cited sources back at least one verified statement and include primary sources used for context.

## The trial

From ClinicalTrials.gov.

- Title: Veterans Affairs Seamless Phase II/III Randomized Trial of STAndard Systemic theRapy With or Without PET-directed Local Therapy for OligoRecurrenT Prostate Cancer (VA STARPORT)
- Also known as: STARPORT
- Registry: NCT04787744 (https://clinicaltrials.gov/study/NCT04787744)
- Study IDs: ONCA-026-20S · 1I01CX002277-01 · CX002277-01 (VA Investigators, Scientific Review and Management)
- Sponsor: VA Office of Research and Development
- Design: Phase 2/Phase 3 · interventional, randomized, parallel, phase2, phase3
- Status: Active, not recruiting
- Enrollment: 378 (actual)
- Start: 2021-07-01 (actual)
- Primary completion: 2026-10-02 (actual)
- Primary endpoint: Castration-resistant prostate cancer-free survival (CRPC-free survival) (4 years)
- Intervention: PET-directed Local Therapy using Surgery (procedure)
- Intervention: PET-directed Local Therapy using Radiation (radiation)
- Intervention: Salvage Local Therapy for locally recurrent disease (other)
- Intervention: Goserelin, Histrelin, Leuprolide & Triptorelin (drug)
- Intervention: ADT + Nilutamide, Flutamide, & Bicalutamide (drug)
- Intervention: Degarelix & Relugolix (drug)
- Intervention: ADT + Docetaxel +/- prednisone (drug)
- Intervention: ADT + Abiraterone + Prednisone (drug)
- Intervention: ADT + Abiraterone + Methylprednisolone (drug)
- Intervention: ADT + Apalutamide (drug)
- Intervention: ADT + Enzalutamide (drug)
- Intervention: Prostate-directed Radiation for De novo oligometastatic prostate cancer (radiation)

## Scope and limits

This report does not judge efficacy, estimate HCP prevalence or consensus or give treatment advice.

- Discussion that does not name the trial may be missing from this edition.
- Some clinician views in the sources used in this report are not yet captured as evidence in this edition.
- Some passages in the sources used in this report were not fully assessed for clinician views, so a view there may be missing from this edition.
- 61 statements in the sources reviewed for this edition are about other patients or topics, or only mention the trial, and are not counted.
- Further source limits apply, so some matching discussion may be missing.
- No full VA STARPORT protocol or trial-specific results publication is included. Speakers’ explanations of planned conduct, possible adaptations and expected benefit should not be treated as completed analyses or confirmed treatment effects.
- Some potentially relevant passages were not fully assessed. Discussion that never named VA STARPORT, used alternative spellings or wording, or preceded registration may be underrepresented.
- The reviewed public discussion does not establish the prevalence of any view among HCPs. Reposts and repeated posts are not additional independent clinical opinions.
- Some speakers' identities or clinical roles are not established in the sources used in this report; each statement is attributed only as far as its source shows.
- A speaker is described in the source as involved in VA STARPORT. The trial explanations and operational observations should not be counted as independent external validation.
- Statements about other trials preserve their own populations, regimens and outcomes. In particular, breast-cancer findings, intermittent-treatment PSA observations and mixed-castration-status pooled results are not VA STARPORT results.
- Source dates span 2020–2026. Site counts, enrollment observations, anticipated timelines and expectations of practice impact are dated statements, not confirmation of current status.
- No exact regulatory labels for several grouped systemic-treatment options were available in the reviewed material. The report does not establish label-specific eligibility or prescribing conclusions.
- Not yet captured in this edition: a view on metastasis-directed therapy in oligorecurrent prostate cancer and the need for stronger evidence across survival endpoints.
- Not yet captured in this edition: a view on restricted access to PSMA PET imaging for PET-directed treatment decisions.

How reports are built and checked: https://www.erudio.com/methods

## Editions and corrections

- v1.0.0, accepted 2026-10-29: current edition, corrected 2026-10-29
  - Correction 2026-10-29: Corrected to match the delivered report: per-finding counts; the limitations; the sample findings. The trial is also known as STARPORT. The page names the trial's tested drugs (none) and indication (oligometastatic prostate cancer).

Last checked for new commentary 2026-10-29. Versions follow semver: a new or changed finding is a minor version, more evidence without a material change is a patch.

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## Cite

Erudio Health. VA STARPORT (NCT04787744): HCP commentary report. Edition 1, v1.0.0. Accepted Oct 29, 2026. https://www.erudio.com/reports/va-starport-nct04787744

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