Androgen Deprivation Therapy on Bone Mineral Density Change in Prostate Cancer Patients

NCT ID: NCT04248621

Last Updated: 2021-07-29

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

164 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-23

Study Completion Date

2022-12-31

Brief Summary

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Androgen deprivation therapy (ADT) is a mainstay of prostate cancer treatment to improve overall survival for intermediate- and high-risk localized disease as well as metastatic disease. While ADT improves survival, it can cause significant morbidity and a decrement in quality of life. In particular, ADT is associated with decrease in bone mineral density (BMD) and increased risk of fracture.

Although current guidelines recommend continuous androgen deprivation therapy (CAD) as standard therapy for high-risk disease, there has been increasing recognition of adverse effects from CAD. Since 1986, intermittent androgen deprivation therapy (IAD) as alternative therapeutic strategy for prostate cancer has been proposed to delay development of castration resistance and to reduce the side effects of ADT.

While both CAD and IAD are commonly used in real clinical practice, no prior study examined BMD change after CAD or IAD, and assessed whether bone loss would recover during off-treatment of IAD. The investigators therefore determine the rate of change in BMD induced by ADT (CAD versus IAD) in men with prostate cancer.

Detailed Description

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Objective: To determine the rate of bone mass loss induced by two therapeutic strategies of ADT (CAD versus IAD) in men with prostate cancer.

Design, setting, and participants: the investigators will perform randomized, open label clinical trial. Men aged over 50 yrs old with prostate cancer (localized, locally advanced, metastatic prostate cancer) who are treated with primary ADT for newly diagnosed prostate cancer or salvage ADT at biochemical recurrence following radical prostatectomy will be included.

Participants will be randomly assigned to one of the following treatment arms:

Arm 1 (CAD): ADT without any discontinuation during study period (12 months).

Arm 2 (IAD): ADT for the first 6 months of study period, if the prostate-specific antigen (PSA) reaches its nadir (\< 4 ng/dL) and serum testosterone reaches castration level (\< 50 ng/dL).

Outcomes:

Primary outcome: change of L-spine total BMD. Secondary outcomes: change of femur neck BMD, incidence rate of osteoporosis, risk of 10 year major osteoporotic fracture, quality of life based on Expanded Prostate Cancer Index (EPIC) questionnaire.

Timing of outcome measurement: at baseline and up to 12 months after randomization.

Statistical analyses: student's t test for continuous outcomes and Fisher's exact or chi-square test for dichotomous outcomes.

Conditions

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Prostatic Neoplasms

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Intermittent Androgen Deprivation

ADT including luteinizing hormone-releasing hormone (LHRH) agonist and antagonist, antiandrogen, or maximum androgen blockade (MAB) should be withdrawn after 6 months of ADT, if the prostate-specific antigen (PSA) reaches its nadir (\< 4 ng/dL) and serum testosterone reaches castration level (\< 50 ng/dL).

Group Type EXPERIMENTAL

Leuprorelin

Intervention Type DRUG

LHRH agonist

Goserelin

Intervention Type DRUG

LHRH agonist

Triptorelin

Intervention Type DRUG

LHRH agonist

Degarelix

Intervention Type DRUG

LHRH antagonist

Bicalutamide

Intervention Type DRUG

Antiandrogen

Flutamide

Intervention Type DRUG

Antiandrogen

Maximum androgen blockade

Intervention Type DRUG

Combination therapy with LHRH agonist and antiandrogen

Continuous Androgen Deprivation

ADT including LHRH agonist and antagonist, antiandrogen, or MAB without any discontinuation during study period.

Group Type ACTIVE_COMPARATOR

Leuprorelin

Intervention Type DRUG

LHRH agonist

Goserelin

Intervention Type DRUG

LHRH agonist

Triptorelin

Intervention Type DRUG

LHRH agonist

Degarelix

Intervention Type DRUG

LHRH antagonist

Bicalutamide

Intervention Type DRUG

Antiandrogen

Flutamide

Intervention Type DRUG

Antiandrogen

Maximum androgen blockade

Intervention Type DRUG

Combination therapy with LHRH agonist and antiandrogen

Interventions

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Leuprorelin

LHRH agonist

Intervention Type DRUG

Goserelin

LHRH agonist

Intervention Type DRUG

Triptorelin

LHRH agonist

Intervention Type DRUG

Degarelix

LHRH antagonist

Intervention Type DRUG

Bicalutamide

Antiandrogen

Intervention Type DRUG

Flutamide

Antiandrogen

Intervention Type DRUG

Maximum androgen blockade

Combination therapy with LHRH agonist and antiandrogen

Intervention Type DRUG

Other Intervention Names

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Leuprorelin acetate Goserelin acetate Triptorelin acetate Degarelix acetate Casodex Niftolide LHRN agonist and antiandrogen

Eligibility Criteria

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Inclusion Criteria

Men aged over 50 yrs old with histologically diagnosed prostate cancer (localized, locally advanced, metastatic prostate cancer) who are treated with primary ADT for newly diagnosed prostate cancer or salvage ADT at biochemical recurrence following radical prostatectomy. .

Exclusion Criteria

1. men with double primary malignancies,
2. men who have been treated with ADT or other drug therapy such as denosumab, bisphosphonate or steroid,
3. men with osteoporosis at baseline (T-score ≤ -2.5),
4. men with a known bone disease,
5. men with poor performance status (i.e. Eastern Cooperative Oncology Group performance status 4),
6. men with life expectancy \< 12 months,
7. men with increased serum PSA levels (≥ 4 ng/dL) or testosterone levels (≥ 50 ng/dL) even after 6 month ADT,
8. men who are not able to understand trial information or informed consent,
Minimum Eligible Age

50 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Eulji University Hospital

OTHER

Sponsor Role collaborator

Wonju Severance Christian Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jinsung Park, MD. PhD.

Role: PRINCIPAL_INVESTIGATOR

Department of Urology, Eulji University, College of Medicine

Locations

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Department of Urology, Chungbuk National University, College of Medicine

Cheongju-si, , South Korea

Site Status RECRUITING

Department of Urology, Kyungpook National University, School of Medicine

Daegu, , South Korea

Site Status RECRUITING

Department of Urology, Yeungnam University, College of Medicine

Daegu, , South Korea

Site Status RECRUITING

Department of Urology, Eulji University, College of Medicine

Daejeon, , South Korea

Site Status RECRUITING

Department of Urology, Konyang University, College of Medicine,

Daejeon, , South Korea

Site Status RECRUITING

Department of Urology, Chonnam National University, School of Medicine

Gwangju, , South Korea

Site Status RECRUITING

Department of Urology, Wonkwang University, School of Medicine

Iksan, , South Korea

Site Status RECRUITING

Department of Urology,Jeonbuk National University Medical School

Jeonju, , South Korea

Site Status RECRUITING

Department of Urology, Pusan National University, School of Medicine

Pusan, , South Korea

Site Status RECRUITING

Department of Urology, Yonsei University Wonju College of Medicine

Wŏnju, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Jinsung Park, MD. PhD.

Role: CONTACT

+82426113533

Facility Contacts

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Seok Joong Yun, MD. PhD.

Role: primary

Tae-Hwan Kim, MD. PhD.

Role: primary

Phil Hyun Song, MD. PhD.

Role: primary

Jinsung Park, MD. PhD.

Role: primary

Dae Seon Yoo, MD. PhD.

Role: backup

Hyung Joon Kim, MD.

Role: primary

Eu Chang Hwang, MD. PhD.

Role: primary

Seung Chol Park, MD. PhD.

Role: primary

Young Beom Jeong, MD. PhD.

Role: primary

Sung Woo Park, MD. PhD.

Role: primary

Jae Hung Jung, MD. PhD.

Role: primary

Other Identifiers

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EMC 2019-12-003-001

Identifier Type: -

Identifier Source: org_study_id

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