Transurethral Prostate Enucleation in Surveillance Protocol for Low Risk Prostate Cancer

Sponsor
Mansoura University (Other)
Overall Status
Active, not recruiting
CT.gov ID
NCT05631080
Collaborator
(none)
50
1
2
116
0.4

Study Details

Study Description

Brief Summary

We will compare oncological and functional outcomes of anatomical endoscopic enucleation of the prostate (AEEP) versus continued medical treatment in low-risk prostate cancer patients for whom an active surveillance protocol was selected.

Condition or Disease Intervention/Treatment Phase
  • Procedure: Anatomical Endoscpic enucleation of the Prostate
Phase 4

Detailed Description

Prostate cancer is the most common cancer in men; in 2018 1,276,106 new cases of prostate cancer were reported worldwide (1).

The diagnosis of prostate cancer is based on the microscopic evaluation of prostate tissue obtained via needle biopsy.

The International Society of Urological Pathology (ISUP) Consensus system assigns new Grade Groups from 1 to 5, derived from the Gleason score (2).

Clinicians have stratified the diagnosis into low, intermediate, and high-risk disease based on the sum of Gleason patterns, prostate specific antigen (PSA) level, and clinical stage (3).

Recently The National Comprehensive Cancer Network risk stratification uses a 5-tier system by adding very low- and very high- as a subdivision of the low- and high-risk groups (4).

Men diagnosed with localized disease (defined as no regional lymph nodes or distant metastases) have 3 primary options: expectant management, surgery and radiation.

Expectant management (monitoring for prostate cancer progression while not undergoing definitive therapy) consists of watchful waiting and active surveillance (5).

According to The Prostate Testing for Cancer and Treatment (ProtecT) trial which randomized 1643 localized prostate cancer men to active monitoring, surgery, or radiation. At 120 months, ProtecT found that 1.5% of patients on active monitoring died from prostate cancer, which did not differ significantly from the 0.9% after surgery or the 0.7% after radiation (6).

The use of active surveillance (AS) for men with low-risk prostate cancer (PCa) is well established, although the criteria for admission to a protocol vary according to the institution. (7-9) Men with significantly enlarged prostates (>100 g) may be assigned a high-risk category when their prostate-specific antigen (PSA) rises above 10 ng/ml, although there is evidence AS is safe in this population. (10) In the presence of lower urinary tract symptoms (LUTS), men with significantly enlarged prostates often undergo radical prostatectomy (RP) to treat PCa and coexisting LUTS. This approach, which prioritizes oncologic control, may increase surgical morbidity for patients who otherwise might continue AS after an outlet procedure to address their LUTS.

The use of holmium laser enucleation of the prostate (HoLEP) for the management of LUTS in men with significantly enlarged prostates and coexisting low-risk PCa has not been prospectively studied. HoLEP has proven to be a safe and effective treatment for men with LUTS. (11) Incidental detection of malignancy at the time of HoLEP ranges from 5% to 13% in men without a prior diagnosis of PCa, and there is evidence PSA has improved sensitivity for cancer progression in the post-HoLEP setting. (12-15) The management of T1a-b PCa incidentally discovered after transurethral resection of prostate (TURP) has been well documented with AS recommended for most patients. (16-18) However, the management of men with known low-risk PCa, clinically significant LUTS, and significantly enlarged prostates remains underexplored.

Herein, we prospectively assess patients with low-risk PCa on AS who underwent AEEP for clinically significant LUTS and enlarged prostate gland size.

Our study focuses on functional and oncologic outcomes.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
50 participants
Allocation:
Non-Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Anatomical Endoscopic Enucleation of the Prostate for Treatment of Bladder Outlet Obstruction in Patients With Low-risk Prostate Cancer on Surveillance Protocol, Prospective Assessment of Functional and Oncological Outcome
Actual Study Start Date :
Jan 1, 2015
Actual Primary Completion Date :
Sep 1, 2022
Anticipated Study Completion Date :
Sep 1, 2024

Arms and Interventions

Arm Intervention/Treatment
No Intervention: Surveillance with medical treatment for bladder outlet obstruction

Patients with low-risk prostate cancer who were elected for active surveillance protocol will have only medical treatment for control of their lower urinary tract symptoms secondary to bladder outlet obstruction

Active Comparator: Surveillance with anatomical endoscopic enucleation of the prostate for bladder outlet obstruction

Patients with low-risk prostate cancer who were elected for active surveillance protocol will be offered anatomical endoscopic enucleation of the prostate for control of their lower urinary tract symptoms secondary to bladder outlet obstruction

Procedure: Anatomical Endoscpic enucleation of the Prostate
Transurethral endoscopic enucleation of the prostate adenoma
Other Names:
  • AEEP
  • Outcome Measures

    Primary Outcome Measures

    1. PSA progression [one year]

      changes of PSA level from baseline to one year follow up following active treatment

    2. radiological progression [one year]

      cancer progression as depicted by multiparametric MRI

    Secondary Outcome Measures

    1. relief of bladder outlet obstruction [one year]

      improvement of urine flow parameters as depicted by peak flow rate (ml/sec)

    2. relief of lower urinary tract symptoms [one year]

      improvement of urinary symptoms as depicted by symptom score (International prostate symptom score)

    3. 2 years progression free survival [2 years]

      PSA, Radiological and grade progression whenever biopsy is indicated

    4. 5 years progression free survival [5 years]

      PSA, Radiological and grade progression whenever biopsy is indicated

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    Male
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    1. Life expectancy >/= 10 years

    2. Low risk prostate cancer with minor institutional amendment of EAU guidelines:

    • PSA < 10 ng/ml or up to 20 ng/ml if PSA density is more than 15%

    • Stage T1, T2a.

    • Gleason score <7 (ISUP grade 1)

    1. Bladder outlet obstruction:
    • IPSS > 9

    • Peak flow rate (Qmax < 15)

    • Imperative indication for BOO surgery

    Exclusion criteria:
    • Patients who are not willing

    • Patients with bladder dysfunction (cystopathy) or other infravesical cause of obstruction other than prostate

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Urology and nephrology center Mansoura DK Egypt 35516

    Sponsors and Collaborators

    • Mansoura University

    Investigators

    • Principal Investigator: Ahmed Elshal, MD, Mansoura University

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Ahmed Elshal, A. Professor of Urology, Mansoura University
    ClinicalTrials.gov Identifier:
    NCT05631080
    Other Study ID Numbers:
    • Mans 22-4-2016
    First Posted:
    Nov 30, 2022
    Last Update Posted:
    Nov 30, 2022
    Last Verified:
    Nov 1, 2022
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Nov 30, 2022