Immediate Curative vs Conservative Treatment in Older Men With M0, High-risk Prostate Cancer

NCT ID: NCT05448547

Last Updated: 2025-07-01

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

PHASE3

Total Enrollment

980 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-11-04

Study Completion Date

2036-12-31

Brief Summary

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It is currently unclear if immediate curative treatment (radiotherapy or surgery) of high-risk prostate cancer without metastasis in older men (\>=75 years) generates the same survival benefits as in younger patients or if the harms/ side-effects of immediate curative treatment outweigh the benefits. In this study the investigators randomize older patients with high-risk, non-metastatic high-risk prostate cancer to either immediate curative therapy or to conservative, more problem-oriented therapy to investigate if immediate curative treatment prolongs life, improves quality of life and is cost-effective.

Detailed Description

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There is a lack of both level 1 evidence and consensus regarding the optimal treatment strategy for older men (\>=75 years) with non-metastatic, high-risk prostate cancer. Currently, in Scandinavia, the majority of older patients are treated conservatively, i.e. with hormone therapy or watchful waiting while some centers recommend immediate curative therapy regardless of patient age. Older patients thus risk both undertreatment and overtreatment of their cancer. This randomized clinical trial investigates if immediate curative therapy of high-risk, non-metastatic prostate cancer prolongs life (as it does in younger patients) and improves health-related quality of life. Furthermore, this trial investigates if the early side effects of immediate curative therapy are compensated by better long-term tumor control, better quality of life, functional status and improved survival.

Conditions

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Prostate Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

randomized, parallel, open-label
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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immediate curative therapy

Patients randomized to the intervention arm will receive immediate curative therapy in the form of either radiotherapy to the prostate in combination with hormone therapy (ADT or monotherapy) or surgery (radical prostatectomy). Standard treatment in this arm is radiotherapy + hormone therapy. Surgery is reserved for patients with strong preferences against radiotherapy.

Group Type EXPERIMENTAL

Radiotherapy or surgery

Intervention Type RADIATION

see arm/ group description

initial observation/ hormone therapy

Patients in this arm will either be observed (with localized high-risk prostate cancer) or receive hormone therapy (locally advanced prostate cancer; ADT or monotherapy). Further local or systemic therapy is given at doctor's discretion triggered by local or/ and systemic progression.

Group Type ACTIVE_COMPARATOR

initial observation

Intervention Type OTHER

see arm/ group description

Hormone therapy

Intervention Type DRUG

androgen depression therapy (ADT) by either LHRH agonist or antagonist or androgen monotherapy

Interventions

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Radiotherapy or surgery

see arm/ group description

Intervention Type RADIATION

initial observation

see arm/ group description

Intervention Type OTHER

Hormone therapy

androgen depression therapy (ADT) by either LHRH agonist or antagonist or androgen monotherapy

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Participant must be 75 years of age or older, at the time of signing the informed consent.
2. Participants who are healthy as determined by medical evaluation and geriatric G8/ miniCOGTM evaluation (G8: Fit, score \>14, or reversibly frail; miniCOGTM: score \>2)

And who have PCa (diagnosed ≤6 months) with one or both of the following features:
* Gleason grade 8-10 (ISUP group 4 and 5) other than microscopic, low-volume disease (tumor must be either palpable or visible on MRI, i.e., PIRADS 4 or 5)
* Locally advanced PCa (T3 or T4) (unequivocal findings of clinical/ radiological T3 or clinical/ radiological T4 on DRE or MRI; broad capsular contact of tumor on MRI is treated as localized disease, T2, in the context of this study)
* Able to read, understand and fill in HRQoL questionnaires (PROMS)
3. Male
4. Capable of giving signed informed consent as described in Appendix 1, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.

Exclusion Criteria

Medical Conditions

1. Dementia (unable to consent) Prior/Concomitant Therapy
2. Prior radiation to the pelvis
3. Hormone therapy \>3 months prior to randomization Diagnostic assessments
4. Lymph node metastasis (N0) on MRI, CT or PSMA-PET CT (equivocal N-findings =N0; borderline cases will be discussed and called by a study tumor board).
5. Distant metastasis (M0) on MRI, CT, bone scan or PSMA-PET CT (equivocal bone scan findings need to be confirmed with MRI or CT; borderline cases will be discussed by a study tumor board).

Other Exclusions
6. Disabled or severe comorbidity (identified by G8 screening)
7. Unable to read, understand or fill out HRQoL questionnaires (PROMS)
Minimum Eligible Age

75 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

Yes

Sponsors

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Oslo University Hospital

OTHER

Sponsor Role collaborator

Klinbeforsk

OTHER

Sponsor Role collaborator

Sven Löffeler

OTHER

Sponsor Role lead

Responsible Party

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Sven Löffeler

Principal investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Sven Loffeler, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

The Hospital of Vestfold

Locations

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Rigshospital

Copenhagen, , Denmark

Site Status RECRUITING

Esbjerg and Grindsted Hospital

Esbjerg, , Denmark

Site Status RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

Helsinki University Hospital

Helsinki, , Finland

Site Status RECRUITING

Tampere University Hospital

Tampere, , Finland

Site Status RECRUITING

Turku University Hospital

Turku, , Finland

Site Status RECRUITING

Sunmøre Hospital Trust

Ålesund, Møre og Romsdal, Norway

Site Status RECRUITING

Oslo University Hospital

Oslo, Oslo County, Norway

Site Status RECRUITING

Stavanger University Hospital

Stavanger, Rogaland, Norway

Site Status RECRUITING

Sørlandet Hospital Trust

Kristiansand, Sørlandet, Norway

Site Status RECRUITING

Telemark Hospital Trust

Skien, Telemark, Norway

Site Status RECRUITING

St. Olavs Hospital

Trondheim, Trøndelag, Norway

Site Status RECRUITING

Vestfold Hospital Trust (Hospital of Vestfold)

Tønsberg, Vestfold, Norway

Site Status RECRUITING

Vestre Viken Hospital Trust

Drammen, , Norway

Site Status RECRUITING

Innlandet Hospital Trust

Hamar, , Norway

Site Status RECRUITING

Akerhus University Hospital

Lørenskog, , Norway

Site Status RECRUITING

University Hospital of Northern Norway

Tromsø, , Norway

Site Status RECRUITING

Capio Saint Göran's Hospital

Stockholm, , Sweden

Site Status RECRUITING

Countries

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Denmark Finland Norway Sweden

Central Contacts

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Sven Loffeler, MD, PhD

Role: CONTACT

+4792235628

Erik S Haug, MD, PhD

Role: CONTACT

+4793030298

Facility Contacts

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Klaus Brasso, Prof, PhD

Role: primary

+45 35 45 35 45

Mads Hvid Aaberg Poulsen, Associate Professor

Role: primary

+45 2176 5418

Grzegorz Lukasz H Fojecki, MD, PhD

Role: primary

+45 63 20 20 00

Antti Rannikko, Professor, MD, PhD

Role: primary

+358 9 4711

Teemu Murtola, Prof, PhD

Role: primary

+358 3 311 611

Otto Ettala, MD, PhD

Role: primary

+358 2 313 0000

Bjørg Aksnessæther

Role: primary

+47 70105000

Kristian Thon, MD, PhD

Role: primary

+47 98227869

Anne Marie Holck Storås, MD, PhD

Role: backup

+47 93208884

Maria Nyre Vigmostad, MD

Role: primary

+47 51518000

Christoph Müller, MD, PhD

Role: primary

+47 90610600

Rasmus Nilsson, MD

Role: primary

+47 35003500

Torgrim M Tandstad, MD, PhD, Professor

Role: primary

+47 72573000

Sven Löffeler

Role: primary

+4733342000 ext. +4733342000

Erik S Haug

Role: backup

+4733342000 ext. +4733342000

Jon G Tyrdal, MD

Role: primary

+47 32803000

Ola Christiansen, MD

Role: primary

+47 915 06 200

Kirsti Aas, MD, PhD

Role: primary

+47 55 97 50 00

Hege S Haugnes, Prof, PhD

Role: primary

+47 776 26000

Karin Holmsten, MD, PhD

Role: primary

+46 8 587 010 00

References

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Loffeler S, Bertilsson H, Muller C, Aas K, Haugnes HS, Aksnessaether B, Pesonen M, Thon K, Tandstad T, Murtola T, Poulsen MH, Nordstrom T, Vigmostad MN, Ottosson F, Holmsten K, Christiansen O, Slaaen M, Haug ES, Storas AH, Asphaug L, Rannikko A, Brasso K; Scandinavian Prostate Cancer Group (SPCG) and the Norwegian Get-Randomized (GRand) Initiative. Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged >/=75 years with non-metastatic high-risk prostate cancer (SPCG 19/GRand-P). BJU Int. 2024 Jun;133(6):680-689. doi: 10.1111/bju.16314. Epub 2024 Mar 12.

Reference Type DERIVED
PMID: 38469686 (View on PubMed)

Other Identifiers

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GrandP

Identifier Type: -

Identifier Source: org_study_id

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