Testosterone Replacement Therapy for the Treatment of Low Testosterone in Hypogonadal Men With Localized Prostate Cancer on Active Surveillance

NCT ID: NCT06733350

Last Updated: 2025-02-04

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

PHASE4

Total Enrollment

600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-15

Study Completion Date

2029-01-15

Brief Summary

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This phase IV trial studies the effects of testosterone replacement therapy (TRT) on treatment outcomes in hypogonadal men with prostate cancer that has not spread to other parts of the body (localized) and who are on active surveillance (AS). AS in prostate cancer involves closely watching the patient's condition through regular physical exams and blood tests, but not giving treatment unless there are changes in test results. It can be a practical alternative to treatment in localized prostate cancer. Hypogonadal men have low testosterone associated with symptoms such as low libido and erectile problems. TRT can be used to treat hypogonadism by increasing testosterone levels, which may improve associated symptoms. TRT is often not used in men with prostate cancer due to concerns it may lead to the cancer growing or spreading. This may lead hypogonadal men to have a poor quality of life or to discontinue AS. TRT may improve treatment and quality of life outcomes in hypogonadal men with localized prostate cancer on active surveillance.

Detailed Description

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PRIMARY OBJECTIVES:

I. To investigate the impact of TRT on Gleason grade progression in hypogonadal men with localized prostate cancer on active surveillance, and the association between TRT and the likelihood of discontinuation of active surveillance in the same population.

II. To assess the impact of TRT on the quality of life, including changes in the International Prostate Symptom Score (IPSS) and the association with sexual health measured by the Sexual Health Inventory for Men (SHIM), in hypogonadal men with localized prostate cancer on active surveillance.

SECONDARY OBJECTIVES:

I. To examine the influence of TRT on radiographic progression in hypogonadal men with localized prostate cancer on active surveillance, by assessing changes in the size of abnormal magnetic resonance imaging (MRI) lesions.

II. To evaluate the association between TRT and biochemical progression by analyzing changes in prostate-specific antigen (PSA) levels over time in the studied population.

III. To systematically monitor and document TRT-related adverse events and complications, and concurrently assess the association between TRT and the likelihood of discontinuation due to adverse events in the studied population.

OUTLINE: Patients are assigned to 1 of 3 groups.

GROUP 1: Patients with normal testosterone level undergo standard AS for up to 5 years in the absence of disease progression. Patients undergo blood sample collection and MRI throughout the trial and may undergo prostate biopsy on study.

GROUP 2: Patients with low testosterone level associated with hypogonadal symptoms and willing to receive TRT receive testosterone per treating physician discretion via injection, gel, lotion, or transdermal patch and undergo standard AS for up to 5 years in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and MRI throughout the trial and may undergo prostate biopsy on study.

GROUP 3: Patients with low testosterone level with no symptoms, or low testosterone level associated with hypogonadal symptoms but declined TRT undergo standard AS for up to 5 years in the absence of disease progression. Patients undergo blood sample collection and MRI throughout the trial and may undergo prostate biopsy on study.

Conditions

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Localized Prostate Carcinoma Stage I Prostate Cancer AJCC v8 Stage II Prostate Cancer AJCC v8 Stage III Prostate Cancer AJCC v8

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1 (AS)

Patients with normal testosterone level undergo standard AS for up to 5 years in the absence of disease progression. Patients undergo blood sample collection and MRI throughout the trial and may undergo prostate biopsy on study.

Group Type ACTIVE_COMPARATOR

Biopsy of Prostate

Intervention Type PROCEDURE

Undergo prostate biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Magnetic Resonance Imaging

Intervention Type PROCEDURE

Undergo MRI

Patient Observation

Intervention Type OTHER

Undergo standard AS

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Group 2 (TRT, AS)

Patients with low testosterone level associated with hypogonadal symptoms and willing to receive TRT receive testosterone per treating physician discretion via injection, gel, lotion, or transdermal patch and undergo standard AS for up to 5 years in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and MRI throughout the trial and may undergo prostate biopsy on study.

Group Type EXPERIMENTAL

Biopsy of Prostate

Intervention Type PROCEDURE

Undergo prostate biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Magnetic Resonance Imaging

Intervention Type PROCEDURE

Undergo MRI

Patient Observation

Intervention Type OTHER

Undergo standard AS

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Therapeutic Testosterone

Intervention Type DRUG

Given via injection, gel, lotion, or transdermal patch

Group 3 (AS)

Patients with low testosterone level with no symptoms, or low testosterone level associated with hypogonadal symptoms but declined TRT undergo standard AS for up to 5 years in the absence of disease progression. Patients undergo blood sample collection and MRI throughout the trial and may undergo prostate biopsy on study.

Group Type ACTIVE_COMPARATOR

Biopsy of Prostate

Intervention Type PROCEDURE

Undergo prostate biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Magnetic Resonance Imaging

Intervention Type PROCEDURE

Undergo MRI

Patient Observation

Intervention Type OTHER

Undergo standard AS

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Interventions

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Biopsy of Prostate

Undergo prostate biopsy

Intervention Type PROCEDURE

Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Magnetic Resonance Imaging

Undergo MRI

Intervention Type PROCEDURE

Patient Observation

Undergo standard AS

Intervention Type OTHER

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Therapeutic Testosterone

Given via injection, gel, lotion, or transdermal patch

Intervention Type DRUG

Other Intervention Names

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Prostate Biopsy Prostatic Biopsy Biological Sample Collection Biospecimen Collected Specimen Collection Magnetic Resonance Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (procedure) Magnetic Resonance Imaging Scan Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance MR MR Imaging MRI MRI Scan MRIs NMR Imaging NMRI Nuclear Magnetic Resonance Imaging sMRI Structural MRI Active Surveillance deferred therapy expectant management Observation Watchful Waiting Mertestate Testoderm Testolin Testosterone Testostroval Testostroval-PA Testro AQ Trans-Testosterone Virosterone

Eligibility Criteria

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Inclusion Criteria

* Men aged ≥ 18 years
* Men with localized prostate cancer are eligible for active surveillance (National Comprehensive Cancer Network \[NCCN\] very low, low, and intermediate favorable risk group)
* Participant must understand the investigational nature of this study and sign an independent ethics committee/institutional review board approved written informed consent form prior to receiving any study related procedure

Exclusion Criteria

* Patients with NCCN intermediate unfavorable, high risk, or very high-risk localized prostate cancer
* Patients with contraindications to TRT, which include,

* Locally advanced or metastatic prostate cancer
* Male breast cancer
* Men with an active desire to have children
* Hematocrit levels \> 54% or baseline hematocrit of 48-50%
* Uncontrolled or poorly controlled congestive heart failure
* IPSS score \> 19
* Family history of venous thromboembolism
* Unwilling or unable to follow protocol requirements
* Any condition which in the investigator's opinion deems the participant an unsuitable candidate to participate in the study
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Roswell Park Cancer Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ahmed Aly

Role: PRINCIPAL_INVESTIGATOR

Roswell Park Cancer Institute

Locations

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Roswell Park Cancer Institute

Buffalo, New York, United States

Site Status RECRUITING

Countries

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United States

Facility Contacts

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Ahmed Aly

Role: primary

716-845-6844

Other Identifiers

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NCI-2024-09551

Identifier Type: REGISTRY

Identifier Source: secondary_id

I-3920923

Identifier Type: OTHER

Identifier Source: secondary_id

I-3920923

Identifier Type: -

Identifier Source: org_study_id

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