Surgery Versus Radiotherapy for Locally Advanced Prostate Cancer

NCT ID: NCT02102477

Last Updated: 2022-03-31

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-10-31

Study Completion Date

2045-12-31

Brief Summary

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This prospective, open randomized phase III surgical trial seeks to study whether radical prostatectomy (with or without the combination of external radiation) improves prostate-cancer specific survival in comparison with primary radiation treatment and hormonal treatment among patients diagnosed with locally advanced (T3) prostate cancer. Untreated or conservatively treated locally advanced prostate cancer is associated with high mortality. Modern curative treatment for advanced solid malign tumors include surgery and/or radiation plus attempted chemotherapy if available to achieve both local control and elimination of potential micro metastases. Whereas there is evidence that surgery can cure localized prostate cancer, there are no clinical trials of multi-modal treatment of locally advanced prostate cancer that includes surgical removal of the prostate.

One potential advantage of adding prostatectomy to the treatment of LAPC is that removing the prostate enables a full pathological assessment of the tumor characteristics and thus a better estimation of the risk of recurrence. Surgical treatment could thus reduce the numbers needed to treat with chemotherapy and radiation, and thus improve quality of life after treatment. In addition, evidence indicate that residual cancer in the prostate occurs in 25% after radiation treatment (56) and surgical removal of the prostate may improve survival beyond what can be achieved by radiation and ADT. On the other hand, patients treated with surgery, radiation and hormones will experience side effects of all three treatment modalities and might fare better if radiotherapy plus hormones can provide oncological control without prior surgery.

A randomized clinical trial comparing two multimodal treatment regimens of which one includes a radical prostatectomy is therefore warranted.

Detailed Description

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Conditions

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Prostatic Neoplasms

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Prostatectomy/Surgery

Patients with locally advanced prostate adenocarcinoma recieves Prostatectomy/Surgery with or without adjuvant or salvage radiotherapy

Group Type EXPERIMENTAL

Prostatectomy/Surgery

Intervention Type PROCEDURE

Radical prostatectomy with or without adjuvant or salvage radiotherapy

Radiotherapy with adjuvant androgen deprivation therapy

Patients with locally advanced prostate adenocarcinoma treated with adjuvant androgen deprivation therapy

Group Type ACTIVE_COMPARATOR

Radiotherapy with adjuvant androgen deprivation therapy

Intervention Type OTHER

Radiotherapy with adjuvant androgen deprivation therapy

Interventions

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Prostatectomy/Surgery

Radical prostatectomy with or without adjuvant or salvage radiotherapy

Intervention Type PROCEDURE

Radiotherapy with adjuvant androgen deprivation therapy

Radiotherapy with adjuvant androgen deprivation therapy

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age ≤75, at the time of randomization
* Diagnosed histopathologically confirmed and untreated prostatic adenocarcinoma
* The general condition and mental status of patients shall permit observation in accordance with the study protocol
* Tumor stage (T, M, N):

T3 stage (as indicated by digital rectal examination or MR imaging or other validated imaging technique) T4 tumors can be included if considered resectable/treatable on MR imaging Significant extra-capsular tumor extension in biopsy (rare but acceptable for inclusion) M0 (no sign of distant metastases) confirmed by bone scan or CT or MRT of axial skeleton (at a maximum of pelvis and lumbar vertebral column) N0 stage, defined in accordance to the RECIST guidelines as no sign of macroscopic retroperitoneal lymph-node metastases \>=1.5 cm (short axis) on CT scan, PET-CT, or MRT or more than one suspected lymph-node metastases Presence Gleason grade pattern 4 or 5

\- Signed Informed consent

Exclusion Criteria

* Patients with a PSA value of \> 100 ng/mL
* Any medical condition that, in the opinion of the investigator, might interfere with the evaluation of the study objectives Patients with contraindications for either prostatectomy or radiotherapy to the prostate are not eligible for the study. Most contraindications for these treatments are relative, but in general, radiotherapy may be precluded among patients with:
* Anorectal disease, such as fistulae, Crohn´s disease, and ulcerative colitis
* Significant obstructive lower urinary tract symptoms
* Proximal stricture of the urethrae
* Severe neurogenic bladder dysfunction
* Enlarged prostate beyond 70-90 ml
* Previous radiotherapy to the pelvic region

On the other hand, surgery may be precluded among patients with:

* Massive local tumor progression, particularly in the apical region
* Massive abdominal obesity
* Contraindications to anesthesia
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Olof Akre

OTHER

Sponsor Role lead

Responsible Party

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Olof Akre

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Johan Stranne, M.D ass prof

Role: PRINCIPAL_INVESTIGATOR

Sahlgrenska University Hospital, Department of Urology, SE- 413 45 Gothenburg

Camilla Thellenberg Karlsson, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Umeå University Hospital, Department of Radiation Science, SE-901 87 Umeå Sweden

Eva M Johansson, R.N PhD

Role: PRINCIPAL_INVESTIGATOR

Karolinska Institute, Nobelsväg, SE- 171 77 Solna, Sweden

Gunnar Steineck, M.D Prof

Role: PRINCIPAL_INVESTIGATOR

Karolinska Institute, Nobelsväg, SE-171 77 Solna, Sweden

Klaus Brasso, M.D

Role: PRINCIPAL_INVESTIGATOR

Rigshospitalet, department Urology, DK-2001-Copenhagen, Denmark

Peter M Meidahl Petersen, M.D ass prof

Role: PRINCIPAL_INVESTIGATOR

Rigshospitalet, Region h, Department of Oncology, Blegdamsvej 9, DK- 2001, Copenhagen, Denmark

Bjørn Brennhovd, M.D ass.prof

Role: PRINCIPAL_INVESTIGATOR

Oslo University Hospital, Department of Urology, P.O Box 4950 Nydalen, N-0424, Oslo Norway

Wolfgang Lilleby, M.D ass.prof

Role: PRINCIPAL_INVESTIGATOR

Oslo University Hospital, Department of Radiation Therapy, P.O Box 4950, N-0424, Nydalen Oslo, Norway

Antti Rannikko, M.D ass.prof

Role: PRINCIPAL_INVESTIGATOR

Helsinki University Central Hospital, Department Urology,Stenbäckinkatu 9, FIN-00290 Helsinki , Finland

Mauri Kouri, M.D PhD

Role: PRINCIPAL_INVESTIGATOR

Helsinki University Central Hospital, Department Urology,Stenbäckinkatu 9, FIN-00290 Helsinki , Finland

Tuomas Mirtti, M.D PhD

Role: PRINCIPAL_INVESTIGATOR

Helsinki University Central Hospital, Department Urology,Stenbäckinkatu 9, FIN-00290 Helsinki , Finland

Locations

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Aalborg University Hospital

Aalborg, , Denmark

Site Status RECRUITING

Aarhus University Hospital

Aarhus, , Denmark

Site Status RECRUITING

Rigshospitalet, Region h, Department Oncology

Copenhagen, , Denmark

Site Status RECRUITING

Rigshopsitalet Department urology

Copenhagen, , Denmark

Site Status RECRUITING

Herlev Hospital

Herlev, , Denmark

Site Status RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

Helsinki University Hospital, Department of Urology

Helsinki, , Finland

Site Status RECRUITING

Tampere University Hospital, Pihlajalinna Koskiklinikka

Tampere, , Finland

Site Status RECRUITING

Turku University Hospital

Turku, , Finland

Site Status RECRUITING

Sørlandet Hospital

Kristiansand, , Norway

Site Status RECRUITING

Oslo University Hospital, Department of radiation Therapy

Oslo, , Norway

Site Status RECRUITING

Oslo University Hospital, Department Urology

Oslo, , Norway

Site Status RECRUITING

University Hospital of North Norway

Tromsø, , Norway

Site Status RECRUITING

St. Olavs Hospital

Trondheim, , Norway

Site Status RECRUITING

Falu Lasarett

Falun, , Sweden

Site Status RECRUITING

Sahlgrenska University Hospital

Gothenburg, , Sweden

Site Status RECRUITING

Helsingborgs Lasarett

Helsingborg, , Sweden

Site Status RECRUITING

Länssjukhuset Ryhov

Jönköping, , Sweden

Site Status RECRUITING

Kirurgkliniken, Blekingesjukhuset

Karlskrona, , Sweden

Site Status RECRUITING

Linköping University Hospital

Linköping, , Sweden

Site Status RECRUITING

Skåne University Hospital

Malmo, , Sweden

Site Status RECRUITING

Vrinevis Hospital

Norrköping, , Sweden

Site Status TERMINATED

Östersund Hospital

Östersund, , Sweden

Site Status RECRUITING

Karolinska University Hospital

Stockholm, , Sweden

Site Status RECRUITING

Capio St Göran Hospital

Stockholm, , Sweden

Site Status RECRUITING

Sundvalls Hospital

Sundsvall, , Sweden

Site Status RECRUITING

Umeå University Hospital

Umeå, , Sweden

Site Status RECRUITING

Uppsala Akademiska Hospital

Uppsala, , Sweden

Site Status RECRUITING

Centrallasarettet

Vaxjo, , Sweden

Site Status RECRUITING

Centrallasarettet Växjö Hospital

Vaxjo, , Sweden

Site Status RECRUITING

Countries

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Denmark Finland Norway Sweden

Central Contacts

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Olof Akre, Prof.

Role: CONTACT

+46-8-517 700 00

Facility Contacts

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Niels Harving, M.D.

Role: primary

Lise Bentzen, M.D.

Role: primary

Peter M Meidahl Petersen, M.D ass

Role: primary

Klaus Brasso, M.D

Role: primary

Henrik Jacobsen, M.D.

Role: primary

Steinbjørn Hansen, M.D.

Role: primary

Antti Rannikko, M.D ass prof

Role: primary

Teuvo Tammela, M.D.

Role: primary

Peter Boström, M.D.

Role: primary

Christoph Müller, Ph.D. M.D.

Role: primary

Wolfgang Lilleby, M.D ass prof

Role: primary

Bjorn Brennhovd, M.D ass prof

Role: primary

Hege Sagstuen, Ph.D.

Role: primary

Torgrim Tandstad, Ph.D.

Role: primary

Hampus Nugin, MD

Role: primary

Johan Stranne, ass prof

Role: primary

Konstantinos Lentaris, MD

Role: primary

Anders Jonsson, MD

Role: primary

Amer Mousa Kadhem, M.D.

Role: primary

+46 455 73 10 00

Per Skoglund, M.D.

Role: primary

Anders Bjartell, MD

Role: primary

Andreas Lundgren, MD

Role: primary

Olof Akre, Prof

Role: primary

Lillemor Nygren, M.D.

Role: primary

Johan Styrke, M.D.

Role: primary

Camilla Thellenberg, M.D PhD

Role: primary

Eva Johanssson, M.D

Role: primary

Amer Elwaheidy, MD

Role: primary

Amer Elwaheidy, M.D.

Role: primary

Other Identifiers

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SPCG-15

Identifier Type: -

Identifier Source: org_study_id

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