A Study of Adding Apalutamide to Radiotherapy and LHRH Agonist in High-Risk Patients With Hormone-Sensitive Prostate Cancer

NCT ID: NCT04557059

Last Updated: 2026-01-16

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

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

694 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-12

Study Completion Date

2029-08-27

Brief Summary

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The main purpose of this study is to determine if the addition of apalutamide to radiotherapy (RT) plus luteinizing hormone-releasing hormone agonist (LHRHa) delays metastatic progression as assessed by prostate specific membrane antigen-positron emission tomography (PSMA-PET) or death compared with RT plus LHRHa alone.

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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Interventional Cohort (Group 1): RT+ LHRHa

Participants will receive radiotherapy (RT) which is defined as prostate-bed plus pelvic lymph node salvage external-beam radiotherapy with or without optional stereotactic body radiation therapy (SBRT), along with a luteinizing hormone-releasing hormone agonist (LHRHa) as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12, or as a 6-monthly depot preparation within 3 days after randomization.

Group Type ACTIVE_COMPARATOR

Radiotherapy

Intervention Type RADIATION

Participants will receive radiotherapy (RT) with or without optional stereotactic body radiation therapy (SBRT), which will start within 4 weeks after randomization.

LHRHa

Intervention Type DRUG

Participants will be administered with LHRHa (example, leuprolide, goserelin, triptorelin acetate) as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12 or as a 6-monthly depot preparation within 3 days after randomization.

Interventional Cohort (Group 2): RT+LHRHa + Apalutamide

Participants will receive prostate-bed plus pelvic lymph node salvage external-beam radiotherapy (RT) with or without optional stereotactic body radiation therapy (SBRT), along with a LHRHa as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12, or as a 6-monthly depot preparation within 3 days after randomization. Participants will also receive 240 milligram (mg) of apalutamide starting within 3 days after randomization as film-coated tablets, to be swallowed whole and together once daily with or without food, for a period of 180 Days.

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Participants will receive radiotherapy (RT) with or without optional stereotactic body radiation therapy (SBRT), which will start within 4 weeks after randomization.

LHRHa

Intervention Type DRUG

Participants will be administered with LHRHa (example, leuprolide, goserelin, triptorelin acetate) as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12 or as a 6-monthly depot preparation within 3 days after randomization.

Apalutamide

Intervention Type DRUG

Participants will receive therapeutic dose of apalutamide 240 mg once daily for 180 Days.

Observational Cohort(Group3) PSMA-PET Negative Participants

Enrollment into this cohort will be stopped further. Participants who were PSMA-PET-negative at screening and were already enrolled in the Observational Cohort will continue in this cohort. Data collected in the course of routine clinical practice during this period will include clinical evaluations, disease progression, therapies administered as per standard-of-care at the study-sites and survival status. For Observational Cohort, information will be entered into the electronic case report form (eCRF) from the medical records at least twice a year. The use of any medicinal product(s) for the treatment and management of participants will be at discretion of the treating physician.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Radiotherapy

Participants will receive radiotherapy (RT) with or without optional stereotactic body radiation therapy (SBRT), which will start within 4 weeks after randomization.

Intervention Type RADIATION

LHRHa

Participants will be administered with LHRHa (example, leuprolide, goserelin, triptorelin acetate) as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12 or as a 6-monthly depot preparation within 3 days after randomization.

Intervention Type DRUG

Apalutamide

Participants will receive therapeutic dose of apalutamide 240 mg once daily for 180 Days.

Intervention Type DRUG

Other Intervention Names

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JNJ-56021927

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed adenocarcinoma of the prostate
* Previously treated with radical prostatectomy with or without lymph node dissection and either: a) for biochemical recurrence after radical prostatectomy (RP): any post-operative prostate-specific antigen (PSA) measurement of less than (\<) 0.1 nanogram/milliliter (ng/mL) within 12 months after RP and without any PSA greater than and equal to (\>=) 0.1 ng/mL within the 4 to 8-week period after RP or b) for persistent PSA after RP: PSA \>=0.1 ng/mL within the 4 to 8-week period after RP, confirmed by additional measurement at least 3 weeks later
* Be able to swallow whole the study drug tablets or follow the instructions for admixing with apple sauce
* Results of the Prostate specific membrane antigen-positron emission tomography (PSMA-PET) at screening as determined by blinded independent, central review (BICR), must be: PSMA-PET-negative for any prostate cancer lesions (that is, no loco-regional lesion and no distant lesions); or PSMA-PET-positive for at least one loco-regional (pelvic) lesion without distant extra-pelvic lesion; or PSMA PET- positive for at least one loco--regional (pelvic) lesion with extra-pelvic lesion(s).
* High risk of developing metastasis defined as; a) for biochemical recurrence after RP: pathological Gleason score greater than or equal to (\>=) 8 evaluated from prostate tissue specimen at radical prostatectomy, or prostate-specific antigen doubling time (PSADT) less than or equal to (\<=) 12 months at the time of screening; b) for persistent PSA after RP: pathological Gleason score \>=8, evaluated from prostate tissue specimen at radical prostatectomy
* Participants with evidence of distant metastasis on screening PSMA-PET scan must have no evidence of prostate cancer metastases on screening CT/MRI of the chest/abdomen/pelvis, Technetium 99m \[99mTc\] whole-body bone scan. Participants with a single bone lesion on 99mTc whole-body bone scan should have confirmatory imaging by CT or MRI; if the confirmatory scan confirms the bone lesion, the participant should be excluded from the study. Conventional images (99mTc-bone scan and CT/MRI) from the screening will be evaluated locally before randomization
* Eastern Cooperative Oncology Group Performance Status Grade 0 or 1

Exclusion Criteria

* History of pelvic radiation for malignancy
* Previous treatment with androgen deprivation therapy (ADT) for prostate cancer
* Previously treated for biochemical recurrence (BCR) or persistent PSA after RP (previous surgical treatment of one or more loco-regional lesions is allowed)
* Prior treatment with a CYP17 inhibitor (example, oral ketoconazole, orteronel, abiraterone acetate, galeterone) or any androgen receptor (AR) antagonist including bicalutamide, flutamide, nilutamide, apalutamide, enzalutamide or darolutamide and any other medications that may lower androgen levels (estrogens, progestins, aminoglutethimide, etc.), including bilateral orchiectomy
* Known or suspected contraindications or hypersensitivity to apalutamide, Luteinizing Hormone-Releasing Hormone (LHRH) agonist or any of the components of the formulations
* Prior chemotherapy for prostate cancer
* Any evidence of prostate cancer metastasis on computed tomography/magnetic resonance imaging (CT/MRI) of the chest/abdomen/pelvis or 99mTc whole-body bone scan, at any time prior to screening
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Janssen Pharmaceutica N.V., Belgium

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Janssen Pharmaceutica N.V., Belgium Clinical Trial

Role: STUDY_DIRECTOR

Janssen Pharmaceutica N.V., Belgium

Locations

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Arizona Urology Specialists

Tucson, Arizona, United States

Site Status

Arkansas Urology

Little Rock, Arkansas, United States

Site Status

Colorado Clinical Research

Lakewood, Colorado, United States

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Urological Research Network

Hialeah, Florida, United States

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First Urology, PSC

Jeffersonville, Indiana, United States

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Michigan Institute of Urology

Troy, Michigan, United States

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Associated Medical Professionals of Ny

Syracuse, New York, United States

Site Status

The Urology Group

Cincinnati, Ohio, United States

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Oregon Urology Institute

Springfield, Oregon, United States

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MidLantic Urology

Bala-Cynwyd, Pennsylvania, United States

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Urology Austin

Austin, Texas, United States

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Houston Metro Urology

Houston, Texas, United States

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Spokane Urology

Spokane, Washington, United States

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Bundaberg Hospital

Bundaberg, , Australia

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Hervey Bay Hospital

Bundaberg, , Australia

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Epworth Healthcare

East Melbourne, , Australia

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St Vincent's Hospital - Melbourne

Fitzroy, , Australia

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Genesis Care Hurstville

Hurstville, , Australia

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Macquarie University Hospital

North Ryde, , Australia

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Calvary Mater Newcastle

Waratah, , Australia

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GenesisCare Wembley

Wembley, , Australia

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Ordensklinikum Linz GmbH Elisabethinen

Linz, , Austria

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Universitaetsklinikum Salzburg Landeskrankenhaus

Salzburg, , Austria

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Medizinische Universitaet Wien

Vienna, , Austria

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ZAS Augustinus

Antwerp, , Belgium

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A.Z. Sint Jan

Bruges, , Belgium

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UZ Gent

Ghent, , Belgium

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Az Groeninge

Kortrijk, , Belgium

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Empresa Brasileira de Servicos Hospitalares - EBSERH - Hospital das Clinicas da UFMG

Belo Horizonte, , Brazil

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Liga Paranaense de Combate ao Cancer

Curitiba, , Brazil

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Liga Norte Riograndense Contra O Cancer

Natal, , Brazil

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Associacao Hospitalar Moinhos de Vento

Porto Alegre, , Brazil

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Irmandade Santa Casa de Misericordia de Porto Alegre

Porto Alegre, , Brazil

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Oncoclinicas Rio de Janeiro S A

Rio de Janeiro, , Brazil

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Hospital Sao Rafael

Salvador, , Brazil

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Sociedade Beneficente de Senhoras Hospital Sirio Libanes

São Paulo, , Brazil

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Hospital Alemao Oswaldo Cruz

São Paulo, , Brazil

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Hospital Sao Camilo Unidade Vila Mariana

São Paulo, , Brazil

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Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein

São Paulo, , Brazil

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Fakultni nemocnice Plzen, Urologicka klinika

Pilsen, , Czechia

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Urocentrum Praha

Prague, , Czechia

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Urologicka klinika 1 LF UK a VFN

Prague, , Czechia

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Fakultni nemocnice v Motole

Prague, , Czechia

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Aalborg University Hospital

Aalborg, , Denmark

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Aarhus University Hospital

Aarhus N, , Denmark

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Rigshospitalet

Copenhagen N, , Denmark

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Gentofte Herlev Hospital

Herlev, , Denmark

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Helsinki University Hospital

Helsinki, , Finland

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Oulu University Hospital

Oulu, , Finland

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Tampere University Hospital

Tampere, , Finland

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Turku University Hospital

Turku, , Finland

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Vaasa Central Hospital

Vaasa, , Finland

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Vivantes Klinikum Am Urban

Berlin, , Germany

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Städtisches Klinikum Braunschweig gGmbH - Standort Salzdahlumer

Braunschweig, , Germany

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Universitatsklinikum Carl Gustav Carcus Dresden

Dresden, , Germany

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Universitatsklinikum Essen

Essen, , Germany

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Klinikum rechts der Isar - der Technischen Universität München

München, , Germany

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Universitaetsklinikum Muenster

Münster, , Germany

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Péterfy Sándor utcai Kórház

Budapest, , Hungary

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Budapesti Bajcsy Zsilinszky Korhaz es Rendelointezet

Budapest, , Hungary

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Orszagos Onkologiai Intezet

Budapest, , Hungary

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Eszak Budai Szent Janos Centrumkorhaz

Budapest, , Hungary

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Budapesti Uzsoki Utcai Korhaz

Budapest, , Hungary

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Jahn Ferenc Del-pesti Korhaz es Rendelointezet

Budapest, , Hungary

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Debreceni Egyetem Klinikai Kozpont

Debrecen, , Hungary

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Radioterapia Oncologica, A.O.U. San'T Orsola

Bologna, , Italy

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Azienda Ospedaliero Universitaria Careggi

Florence, , Italy

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Ospedale San Raffaele

Milan, , Italy

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Fondazione Policlinico Tor Vergata

Roma, , Italy

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Istituto Nazionale Tumori Regina Elena

Roma, , Italy

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Azienda Ospedaliera Sant Andrea

Roma, , Italy

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King Hussein Cancer Center

Amman, , Jordan

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St Georges Hospital university medical centre

Beirut, , Lebanon

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American Universitty of Beirut Medical Center

Beirut, , Lebanon

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Notre Dame De Secours

Byblos, , Lebanon

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Centre Hospitalier du Nord

Zghartā, , Lebanon

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Consultorio de Especialidad en Urologia Privado

Durango, , Mexico

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Hospital MAC Leon

León, , Mexico

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Avix Investigacion Clinica S C

Monterrey, , Mexico

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Oncologia Integral Satelite

Naucalpan, , Mexico

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Centro de Investigacion Clinica de Oaxaca

Oaxaca City, , Mexico

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Oncocenter

Puebla City, , Mexico

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Cuidados Oncologicos

Querétaro, , Mexico

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Centrum Onkologii im Prof F Lukaszczyka w Bydgoszczy

Bydgoszcz, , Poland

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NU-MED Grupa S.A Centrum Radioterapii i Onkologii

Elblag, , Poland

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Uniwersyteckie Centrum Kliniczne

Gdansk, , Poland

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Szpitale Pomorskie Sp z o o

Gdynia, , Poland

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Swietokrzyskie Centrum Onkologii SPZOZ w Kielcach

Kielce, , Poland

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Szpital Wojewodzki im Mikolaja Kopernika w Koszalinie

Koszalin, , Poland

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Wojewodzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im M Kopernika w Lodzi

Lodz, , Poland

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Radomskie Centrum Onkologii

Radom, , Poland

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Narodowy Instytut Onkologii im Marii Sklodowskiej Curie Panstwowy Instytut Badawczy

Warsaw, , Poland

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Ipo Lisboa

Lisbon, , Portugal

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Hosp. Cuf Tejo

Lisbon, , Portugal

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Fund. Champalimaud

Lisbon, , Portugal

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Uls Lisboa Ocidental - Hosp. Sao Francisco Xavier

Lisbon, , Portugal

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Hosp. Da Luz Lisboa

Lisbon, , Portugal

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Uls Santa Maria - Hosp. Santa Maria

Lisbon, , Portugal

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Uls Santo Antonio - Hosp. Santo Antonio

Porto, , Portugal

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Uls de Entre Douro E Vouga - Hosp. Sao Sebastiao

Santa Maria da Feira, , Portugal

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Ivanovo Regional Oncology Dispensary

Ivanovo, , Russia

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City Clinical Hospital #57

Moscow, , Russia

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I.M. Sechenov First Moscow State Medical University

Moscow, , Russia

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Hertzen Oncology Research Institute

Moscow, , Russia

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Leningrad Regional Oncology Dispensary

Saint Petersburg, , Russia

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SPb SBIH 'City Clinical Oncological Dispensary'

Saint Petersburg, , Russia

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Multifunctional clinical medical center 'Medical city'

Tyumen, , Russia

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SHI Sverdlovsk Regional Clinical Hospital #1

Yekaterinburg, , Russia

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CUIMED - urologická ambulancia

Bratislava, , Slovakia

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Východoslovenský Onkologický Ústav

Košice, , Slovakia

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Univerzitná nemocnica Martin

Martin, , Slovakia

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Uroexam s.r.o.

Nitra, , Slovakia

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Urologicka ambulancia e.cho Poprad, s.r.o

Poprad, , Slovakia

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MILAB s.r.o.

Prešov, , Slovakia

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Privátna urologická ambulancia

Trenčín, , Slovakia

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Hospital Universitario Puerto Del Mar

Cadiz, , Spain

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Hosp. Arquitecto Marcide

Ferrol, , Spain

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Hosp. de Jerez de La Frontera

Jerez de la Frontera, , Spain

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Hosp. Univ. 12 de Octubre

Madrid, , Spain

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Hosp. Univ. de La Paz

Madrid, , Spain

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Hosp Virgen de La Victoria

Málaga, , Spain

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Clinica Univ. de Navarra

Pamplona, , Spain

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Hosp. de Navarra

Pamplona, , Spain

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Hosp. Virgen Del Rocio

Seville, , Spain

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Hosp. Univ. I Politecni La Fe

Valencia, , Spain

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Hosp. Clinico Univ. Lozano Blesa

Zaragoza, , Spain

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Urologiska Mottagningen

Malmo, , Sweden

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Prostatacancercentrum

Stockholm, , Sweden

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Sodersjukhuset

Stockholm, , Sweden

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Adana Baskent Yuregir Hospital

Adana, , Turkey (Türkiye)

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Hacettepe University Medical Faculty

Ankara, , Turkey (Türkiye)

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Memorial Ankara Hastanesi

Ankara, , Turkey (Türkiye)

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Ankara University Medical Faculty

Ankara, , Turkey (Türkiye)

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Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital

Ankara, , Turkey (Türkiye)

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Koc University, School of Medicine, Koc University Hospital

Istanbul, , Turkey (Türkiye)

Site Status

Istanbul University Cerrahpasa Medical Faculty

Istanbul, , Turkey (Türkiye)

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Bakirkoy Training and Research Hospital

Istanbul, , Turkey (Türkiye)

Site Status

Goztepe Prof Dr Suleyman Yalcin Sehir Hastanesi

Istanbul, , Turkey (Türkiye)

Site Status

Kartal Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi

Istanbul, , Turkey (Türkiye)

Site Status

Dokuz Eylul Universitesi Tip Fakultesi

Izmir, , Turkey (Türkiye)

Site Status

Sakarya Üniversitesi Tıp Fakültesi Hastanesi

Sakarya, , Turkey (Türkiye)

Site Status

Countries

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United States Australia Austria Belgium Brazil Czechia Denmark Finland Germany Hungary Italy Jordan Lebanon Mexico Poland Portugal Russia Slovakia Spain Sweden Turkey (Türkiye)

Other Identifiers

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56021927PCR3015

Identifier Type: OTHER

Identifier Source: secondary_id

2019-002957-46

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

2023-505852-23-00

Identifier Type: REGISTRY

Identifier Source: secondary_id

CR108705

Identifier Type: -

Identifier Source: org_study_id

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