Nerve-Sparing Radical Prostatectomy With or Without Nerve Grafting Followed by Standard Therapy for Erectile Dysfunction in Treating Patients With Localized Prostate Cancer

NCT ID: NCT00080808

Last Updated: 2012-07-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

111 participants

Study Classification

INTERVENTIONAL

Study Start Date

2001-08-31

Study Completion Date

2009-07-31

Brief Summary

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RATIONALE: Nerve-sparing radical prostatectomy with nerve grafting followed by standard therapies for erectile dysfunction may be effective in helping patients with prostate cancer improve sexual satisfaction and quality of life. It is not yet known whether erectile dysfunction therapy and nerve-sparing prostatectomy are more effective with or without nerve grafting.

PURPOSE: This randomized phase II trial is studying nerve grafting and standard therapy to see how well they work compared to standard therapy alone in treating erectile dysfunction in patients undergoing nerve-sparing radical prostatectomy for localized prostate cancer.

Detailed Description

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OBJECTIVES:

* Compare the efficacy of erectile dysfunction rehabilitation and unilateral cavernous nerve-sparing radical prostatectomy with versus without unilateral autologous interposition sural nerve grafting in patients with clinically localized prostate cancer.
* Compare potency rates in patients treated with these regimens.
* Compare erection quality in patients treated with these regimens.
* Compare time to return of spontaneous erectile activity in patients treated with these regimens.
* Compare the feasibility of these regimens in these patients.
* Compare quality of life and sexual satisfaction in patients treated with these regimens.
* Compare changes in penile erectile length and circumference in patients treated with these regimens.
* Compare the relative morbidity of patients treated with these regimens.

OUTLINE: This is a randomized, open-label study. Patients are randomized to 1 of 2 treatment arms.

* Arm I: Patients undergo unilateral cavernous nerve-sparing radical prostatectomy with unilateral autologous interposition sural nerve grafting.

Beginning 6 weeks after surgery, patients undergo erectile dysfunction rehabilitation comprising any of the following: oral sildenafil (as occasion requires), use of vacuum erection device over 10 minutes once daily, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly, or MUSE (suppository in urethra for erections) therapy. Erectile dysfunction rehabilitation may continue for up to 2 years or until return of adequate spontaneous erectile activity.

* Arm II: Patients undergo unilateral cavernous nerve-sparing radical prostatectomy (without sural nerve grafting) and erectile dysfunction rehabilitation as in arm I.

In both arms, treatment continues in the absence of unacceptable toxicity.

Quality of life and sexual history are assessed at baseline, at 6 weeks postoperatively, at 4, 8, 12, and 16 months, and then every 4 months for 2 years or until return of spontaneous erectile activity.

Patients are followed every 4 months for 2 years.

PROJECTED ACCRUAL: A total of 200 patients (120 for arm I and 80 for arm II) will be accrued for this study.

Conditions

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Prostate Cancer

Keywords

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perioperative/postoperative complications sexual dysfunction and infertility sexuality and reproductive issues adenocarcinoma of the prostate stage I prostate cancer stage II prostate cancer prostaglandin E1 papaverine phentolamine Nerve-sparing radical prostatectomy nerve grafting

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Arm I

Patients undergo unilateral cavernous nerve-sparing radical prostatectomy with unilateral autologous interposition sural nerve grafting.

Group Type ACTIVE_COMPARATOR

Alprostadil (E1)

Intervention Type DRUG

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Papaverine

Intervention Type DRUG

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Phentolamine mesylate

Intervention Type DRUG

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Sildenafil citrate

Intervention Type DRUG

Oral sildenafil as needed

conventional surgery

Intervention Type PROCEDURE

Unilateral cavernous nerve sparing radical retropubic prostatectomy

Arm II (No sural nerve grafting)

Patients undergo unilateral cavernous nerve-sparing radical prostatectomy (without sural nerve grafting) and erectile dysfunction rehabilitation as in arm I.

Group Type ACTIVE_COMPARATOR

Alprostadil (E1)

Intervention Type DRUG

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Papaverine

Intervention Type DRUG

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Phentolamine mesylate

Intervention Type DRUG

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Sildenafil citrate

Intervention Type DRUG

Oral sildenafil as needed

conventional surgery

Intervention Type PROCEDURE

Unilateral cavernous nerve sparing radical retropubic prostatectomy

Interventions

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Alprostadil (E1)

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Intervention Type DRUG

Papaverine

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Intervention Type DRUG

Phentolamine mesylate

Beginning 6 weeks after surgery, intracavernous Triplemix (prostaglandin E1, papaverine, and phentolamine) injected twice weekly

Intervention Type DRUG

Sildenafil citrate

Oral sildenafil as needed

Intervention Type DRUG

conventional surgery

Unilateral cavernous nerve sparing radical retropubic prostatectomy

Intervention Type PROCEDURE

Other Intervention Names

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Prostaglandin E1 PGE1 Paverine Injection Papaverine Hydrochloride Injection Viagra prostatectomy

Eligibility Criteria

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Inclusion Criteria

1. Patient must be a candidate for a unilateral nerve sparing radical retropubic prostatectomy. a) Gleason score 7 or less in the cores on the side to be spared
2. Patient must have no discernable preoperative erectile dysfunction, defined as the ability to have successful penetration on at least 75% of attempts.
3. Patient must be \</= 65 years of age at the time of study enrollment.
4. Patient must have no peripheral neuropathy precluding procurement of a sural nerve graft
5. Patient must have no significant psychiatric illness or demonstrable vasculogenic source of impotence.
6. No prior history of pelvic irradiation or androgen deprivation therapy (LHRH agonists or anti-androgens)
Maximum Eligible Age

65 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

M.D. Anderson Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Christopher G. Wood, MD

Role: STUDY_CHAIR

M.D. Anderson Cancer Center

Locations

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M.D. Anderson Cancer Center at University of Texas

Houston, Texas, United States

Site Status

Countries

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United States

References

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Davis JW, Chang DW, Chevray P, Wang R, Shen Y, Wen S, Pettaway CA, Pisters LL, Swanson DA, Madsen LT, Huber N, Troncoso P, Babaian RJ, Wood CG. Randomized phase II trial evaluation of erectile function after attempted unilateral cavernous nerve-sparing retropubic radical prostatectomy with versus without unilateral sural nerve grafting for clinically localized prostate cancer. Eur Urol. 2009 May;55(5):1135-43. doi: 10.1016/j.eururo.2008.08.051. Epub 2008 Sep 2.

Reference Type RESULT
PMID: 18783876 (View on PubMed)

Related Links

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http://www.mdanderson.org

UT MD Anderson Cancer Center Website

Other Identifiers

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P50CA090270

Identifier Type: NIH

Identifier Source: secondary_id

View Link

P30CA016672

Identifier Type: NIH

Identifier Source: secondary_id

View Link

MDA-ID-01304

Identifier Type: OTHER

Identifier Source: secondary_id

CDR0000355366

Identifier Type: REGISTRY

Identifier Source: secondary_id

ID01-304

Identifier Type: -

Identifier Source: org_study_id