PROS-1-Male Hormonal Contraceptive Regimens on Prostate Tissue
NCT ID: NCT00490555
Last Updated: 2013-11-15
Study Results
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View full resultsBasic Information
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COMPLETED
PHASE2/PHASE3
32 participants
INTERVENTIONAL
2009-01-31
2012-03-31
Brief Summary
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The investigators will test the hypothesis that exogenous T administration that results in increased circulating T and dihydrotestosterone (DHT) levels will increase intraprostatic concentrations of T and its metabolite DHT.
The investigators will test the hypothesis that the addition of a potent 5α-reductase inhibitor, dutasteride, or the progestin, Depomedoxyprogesterone (IM DMPA), to T administration in young and middle aged men will decrease intraprostatic DHT and increase intraprostatic T concentrations compared to T alone.
The investigators will test the hypothesis that the addition of a 5α-reductase inhibitor dutasteride or the progestin IM DMPA to exogenous T, by reducing intraprostatic DHT, will decrease prostate epithelial proliferation, assessed by Ki-67 labeling index (Ki-67LI), and increase apoptosis, assessed by caspase-3 expression, and decrease androgen-regulated protein expression such as prostate specific antigen (PSA).
The investigators will test the hypothesis that the addition of a 5α-reductase inhibitor or the progestin IM DMPA to exogenous T, by modifying the intraprostatic hormonal milieu, will alter prostate epithelial gene expression. Specifically, the investigators expect that the addition of the 5α-reductase inhibitor dutasteride or the progestin IM DMPA to exogenous T, will result in decreased expression of androgen-regulated genes such as PSA.
Detailed Description
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We will be administering three drugs in this study: Testim (testosterone (T) gel), dutasteride (which affects testosterone break down) and Depomedoxyprogesterone (DMPA, a progestin). We want to see their effects on levels of hormones in the blood and prostate. In addition, we will be examining the effects of these drugs on the expression of genes within the prostate. DMPA suppresses LH and FSH, which are hormones made by the pituitary gland, thus blocking the signal from the brain that causes the testes to make testosterone. Prolonged (\> 1 month) low levels of LH and FSH cause decreased sperm production in normal men. However, men may experience some side effects from the low levels of testosterone caused by DMPA; adding testosterone to DMPA eliminates these side effects while more effectively blocking LH and FSH release and sperm production. This combination of drugs is a promising male contraceptive regimen. However, the effect of these drugs on the prostate is not known. Some studies suggest that testosterone administration may promote prostate growth. Dutasteride blocks the conversion of testosterone to dihydrotestosterone and is used to treat men with enlarged prostates. Dutasteride shrinks the prostate. It is possible that combining testosterone and dutasteride may be an effective part of a male hormonal contraceptive regime. Therefore, further studies examining the effect of testosterone, DMPA and dutasteride on the prostate are needed.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
DOUBLE
Study Groups
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1
Placebo gel + Placebo pill + placebo injection
Placebo Testosterone gel
Place gel applied daily for 12 weeks
Placebo dutasteride
placebo pill for 12 weeks
Placebo DMPA
placebo DMPA injection Once
2
Testosterone 1% transdermal gel 10 g + placebo pill + placebo injection
Testosterone gel
Testosterone gel 10 g
3
Testosterone 1% transdermal gel 10 g + dutasteride 0.5 mg Orally + placebo injection
Testosterone gel
Testosterone gel 10 g
Dutasteride
dutasteride 0.5 mg orally
4
Testosterone 1% transdermal gel 10 g + placebo pill + DMPA 300 mg injection (IM)
Testosterone gel
Testosterone gel 10 g
Depo-Medroxyprogesterone (DMPA)
300 mg DMPA injection on Day 0 IM (into the muscle)
Placebo dutasteride
placebo pill for 12 weeks
Interventions
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Testosterone gel
Testosterone gel 10 g
Dutasteride
dutasteride 0.5 mg orally
Depo-Medroxyprogesterone (DMPA)
300 mg DMPA injection on Day 0 IM (into the muscle)
Placebo Testosterone gel
Place gel applied daily for 12 weeks
Placebo dutasteride
placebo pill for 12 weeks
Placebo DMPA
placebo DMPA injection Once
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* PSA ≤ 2.
* Age 25-55 years
* Ability to understand the study,study procedures and provide consent
* Normal serum total T, LH, FSH, urine analyses, and sperm count \> or equal to 15million/ml
* International Prostate Symptom Score (IPSS) \< 10
* Normal seminal fluid analysis (\>20 million sperm/ml)
* Agree not to donate blood during the treatment and recovery periods
Exclusion Criteria
* History of invasive therapy for BPH
* History of acute urinary retention
* Current or past treatment with a 5α-reductase inhibitor
* History of anti/androgenic drugs or drugs that interfere with steroid metabolism within past 3 months
* Severe systemic illness (renal, liver, cardiac, lung disease, cancer, poorly controlled diabetes)
* Known untreated obstructive sleep apnea
* Hematocrit \> 52%
* Skin disease that might interfere with T gel absorption
* Hypersensitivity to any of the drugs used in the study
* History of a bleeding disorder or anticoagulation
* History of drug or alcohol abuse within 12 months
* History of infertility or desire for fertility within 12 months, or current pregnant partner
* A first-degree relative (i.e. father, brother) with a history of prostate cancer
* Abnormal digital rectal examination or prostate ultrasound
25 Years
55 Years
MALE
Yes
Sponsors
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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
NIH
University of Washington
OTHER
Responsible Party
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Stephanie T. Page
Associate Professor
Principal Investigators
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Stephanie T Page, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
University of Washington
Locations
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University of Washington
Seattle, Washington, United States
Countries
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References
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Amory JK, Page ST, Bremner WJ. Drug insight: Recent advances in male hormonal contraception. Nat Clin Pract Endocrinol Metab. 2006 Jan;2(1):32-41. doi: 10.1038/ncpendmet0069.
Brady BM, Amory JK, Perheentupa A, Zitzmann M, Hay CJ, Apter D, Anderson RA, Bremner WJ, Pollanen P, Nieschlag E, Wu FC, Kersemaekers WM. A multicentre study investigating subcutaneous etonogestrel implants with injectable testosterone decanoate as a potential long-acting male contraceptive. Hum Reprod. 2006 Jan;21(1):285-94. doi: 10.1093/humrep/dei300. Epub 2005 Sep 19.
Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. Am J Obstet Gynecol. 2004 Apr;190(4 Suppl):S5-22. doi: 10.1016/j.ajog.2004.01.061.
Jacobsen SJ, Girman CJ, Lieber MM. Natural history of benign prostatic hyperplasia. Urology. 2001 Dec;58(6 Suppl 1):5-16; discussion 16. doi: 10.1016/s0090-4295(01)01298-5.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66. doi: 10.3322/canjclin.57.1.43.
Wilson JD, George FW. The Physiology of Reproduction. Raven Press, 1994
Russell DW, Wilson JD. Steroid 5 alpha-reductase: two genes/two enzymes. Annu Rev Biochem. 1994;63:25-61. doi: 10.1146/annurev.bi.63.070194.000325. No abstract available.
Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, Lieber MM, Cespedes RD, Atkins JN, Lippman SM, Carlin SM, Ryan A, Szczepanek CM, Crowley JJ, Coltman CA Jr. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003 Jul 17;349(3):215-24. doi: 10.1056/NEJMoa030660. Epub 2003 Jun 24.
Geller J. Effect of finasteride, a 5 alpha-reductase inhibitor on prostate tissue androgens and prostate-specific antigen. J Clin Endocrinol Metab. 1990 Dec;71(6):1552-5. doi: 10.1210/jcem-71-6-1552.
Geller J, Albert J. Effects of castration compared with total androgen blockade on tissue dihydrotestosterone (DHT) concentration in benign prostatic hyperplasia (BPH). Urol Res. 1987;15(3):151-3. doi: 10.1007/BF00254427.
Mohler JL, Gregory CW, Ford OH 3rd, Kim D, Weaver CM, Petrusz P, Wilson EM, French FS. The androgen axis in recurrent prostate cancer. Clin Cancer Res. 2004 Jan 15;10(2):440-8. doi: 10.1158/1078-0432.ccr-1146-03.
Forti G, Salerno R, Moneti G, Zoppi S, Fiorelli G, Marinoni T, Natali A, Costantini A, Serio M, Martini L, et al. Three-month treatment with a long-acting gonadotropin-releasing hormone agonist of patients with benign prostatic hyperplasia: effects on tissue androgen concentration, 5 alpha-reductase activity and androgen receptor content. J Clin Endocrinol Metab. 1989 Feb;68(2):461-8. doi: 10.1210/jcem-68-2-461.
Habib FK, Ross M, Tate R, Chisholm GD. Differential effect of finasteride on the tissue androgen concentrations in benign prostatic hyperplasia. Clin Endocrinol (Oxf). 1997 Feb;46(2):137-44. doi: 10.1046/j.1365-2265.1997.950908.x.
Page ST, Lin DW, Mostaghel EA, Hess DL, True LD, Amory JK, Nelson PS, Matsumoto AM, Bremner WJ. Persistent intraprostatic androgen concentrations after medical castration in healthy men. J Clin Endocrinol Metab. 2006 Oct;91(10):3850-6. doi: 10.1210/jc.2006-0968. Epub 2006 Aug 1.
Page ST, Amory JK, Anawalt BD, Irwig MS, Brockenbrough AT, Matsumoto AM, Bremner WJ. Testosterone gel combined with depomedroxyprogesterone acetate is an effective male hormonal contraceptive regimen and is not enhanced by the addition of a GnRH antagonist. J Clin Endocrinol Metab. 2006 Nov;91(11):4374-80. doi: 10.1210/jc.2006-1411. Epub 2006 Aug 29.
Other Identifiers
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RFA-HD-06-014;
Identifier Type: -
Identifier Source: secondary_id
06-4795-A 01
Identifier Type: OTHER
Identifier Source: secondary_id
31434-A
Identifier Type: -
Identifier Source: org_study_id