BAseLine TEstosterone as a Prognostic and/or Predictive bioMARKer in mHSPC

NCT ID: NCT05530395

Last Updated: 2022-09-14

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

NOT_YET_RECRUITING

Total Enrollment

300 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-01-01

Study Completion Date

2026-01-01

Brief Summary

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Despite large amounts of basic-science data supporting a role for androgens in PCa pathogenesis, there are conflicting clinical data on the role of endogenous testosterone in human de novo PCa pathogenesis. The investigators hypothesize that lower baseline serum testosterone is significantly associated with worse clinical outcomes in mHSPC patients undergoing continuous medical castration

Detailed Description

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Biological rationale:

The 'androgen hypothesis' asserts that prostate cancer (PCa) development and progression is driven by androgens. There is significant evidence that androgens promote prostate cancer in experimental models. However, there is no clear evidence that elevations in endogenous testosterone levels promote the development of prostate cancer in humans. Indeed, despite large amounts of basic-science data supporting a role for androgens in PCa pathogenesis, there are conflicting clinical data on the role of endogenous testosterone in human PCa pathogenesis de novo. In reviewing the literature involving PCa development in PCa naive patients, there are studies implicating elevated testosterone, studies implicating lower testosterone, and studies with no association of testosterone and PCa risk.

A recent review in 2015 delved into the controversial role of androgens and prostate cancer and explains the different theories about the ambiguous action of testosterone on the prostate. In 2012, a research proposed the nonlinear U-shaped behaviour or time dependency theory, which postulates that the endocrine biology of the prostate tissue depends on exposure time at a given androgen concentration, which "relies on the fluctuation of the levels of circulating sex steroids during the lifespan of the individual". Another model is the saturation model based on the observations that prostate tissue is extremely sensitive to changes in serum testosterone at low concentrations. This model suggests that there is a nonprotective effect of low testosterone against PCa but tissue becomes indifferent to changes when increasing androgen concentration reach a limit (saturation point), beyond which no further androgen-driven changes are observed. Anyway, the lack of a satisfying model to explain the relationship between androgens and PCa is simply the consequence of insufficient knowledge of the real intrinsic physiopathology of this disease.

Clinical rationale:

Approximately 15% of mHSPC patients primarily fail to respond to ADT. A recent consensus statement on circulating biomarkers for advanced prostate cancer highlighted the urgent need for prospective trials to clinically qualify circulating biomarkers, the greatest need being metastatic PCa. On the other hand, a very recent paper analysed baseline testosterone in hormone-naïve advanced PCa patients undergoing continuous medical castration and selected from 2 large Phase III RCTs. It demonstrated that lower baseline serum testosterone was significantly associated with worse survival end-points and warrants further prospective research in this scenario.

In this era of complex and expensive next-generation markers, this simple, cheap, and well-known biomarker may still have something to say in PCa.

Conditions

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Prostate Cancer Metastatic

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Testosterone levels

Blood sample to determine testosterone levels

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Metastatic hormone sensitive prostate cancer (mHSPC) patients diagnosed by any imaging test (at least CT and bone scan) including:

* Any newly diagnosed mHSPC with no prior treatments.
* Primarily treated PCa that have progressed to mHSPC with no prior ADT in the last 2 years.
* Patients receiving ADT + EBRT as primary treatment will also be included.
* Patients who agree to be followed prospectively according to routine clinical practice in the context of this study.

Exclusion Criteria

* Any prior androgen deprivation therapy (ADT) scheme 2 years before recruitment. - Any prior testosterone replacement therapy scheme 2 years before recruitment.
* Previous intermittent ADT schemes.
* Prior testicular excision surgery.
* Absence or testicular atrophy from any cause.
* Whenever further prospective clinical follow-up is not possible or patient do not accept follow-up in the context of this study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

89 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitario Reina Sofia de Cordoba

OTHER_GOV

Sponsor Role collaborator

Hospitales Universitarios Virgen del Rocío

OTHER

Sponsor Role collaborator

Hospital Universitario Torrecárdenas

OTHER

Sponsor Role collaborator

Hospital Neurotraumatologico de Jaen

OTHER

Sponsor Role collaborator

Hospital San Carlos, Madrid

OTHER

Sponsor Role collaborator

Institut Mutualiste Montsouris

OTHER

Sponsor Role collaborator

San Raffaele University Hospital, Italy

OTHER

Sponsor Role collaborator

Azienda Ospedaliera San Giovanni Battista

OTHER

Sponsor Role collaborator

Chinese University of Hong Kong

OTHER

Sponsor Role collaborator

Medical University Innsbruck

OTHER

Sponsor Role collaborator

University of Padova

OTHER

Sponsor Role collaborator

UMC Utrecht

OTHER

Sponsor Role collaborator

Ignacio Puche Sanz

OTHER

Sponsor Role lead

Responsible Party

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Ignacio Puche Sanz

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Ignacio Puche

Role: PRINCIPAL_INVESTIGATOR

Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO)

Locations

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Hospital Universitario Reina Sofía

Córdoba, Andalusia, Spain

Site Status

Hospital Universitario Virgen de las Nieves

Granada, Andalusia, Spain

Site Status

Hospital Universitario Virgen del Rocio

Seville, , Spain

Site Status

Countries

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Spain

Central Contacts

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Ignacio Puche Sanz

Role: CONTACT

0034 958 023 158

Soraya Santana

Role: CONTACT

0034 958 023 158

References

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Michaud JE, Billups KL, Partin AW. Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk. Ther Adv Urol. 2015 Dec;7(6):378-87. doi: 10.1177/1756287215597633.

Reference Type BACKGROUND
PMID: 26622322 (View on PubMed)

Pierorazio PM, Ferrucci L, Kettermann A, Longo DL, Metter EJ, Carter HB. Serum testosterone is associated with aggressive prostate cancer in older men: results from the Baltimore Longitudinal Study of Aging. BJU Int. 2010 Mar;105(6):824-9. doi: 10.1111/j.1464-410X.2009.08853.x. Epub 2009 Sep 14.

Reference Type BACKGROUND
PMID: 19751256 (View on PubMed)

Yano M, Imamoto T, Suzuki H, Fukasawa S, Kojima S, Komiya A, Naya Y, Ichikawa T. The clinical potential of pretreatment serum testosterone level to improve the efficiency of prostate cancer screening. Eur Urol. 2007 Feb;51(2):375-80. doi: 10.1016/j.eururo.2006.08.047. Epub 2006 Sep 12.

Reference Type BACKGROUND
PMID: 17005316 (View on PubMed)

Rajek NJ. Developing an evening clinical experience for baccalaureate community health nursing students. J Nurs Educ. 1987 May;26(5):197-200. doi: 10.3928/0148-4834-19870501-07.

Reference Type BACKGROUND
PMID: 3035140 (View on PubMed)

Other Identifiers

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BATEMARK-YAUPCa-21

Identifier Type: -

Identifier Source: org_study_id

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