SPCG-15: Surgery Versus Radiotherapy for Locally Advanced Prostate Cancer
Study Details
Study Description
Brief Summary
This prospective, open randomized phase III surgical trial seeks to study whether radical prostatectomy (with or without the combination of external radiation) improves prostate-cancer specific survival in comparison with primary radiation treatment and hormonal treatment among patients diagnosed with locally advanced (T3) prostate cancer. Untreated or conservatively treated locally advanced prostate cancer is associated with high mortality. Modern curative treatment for advanced solid malign tumors include surgery and/or radiation plus attempted chemotherapy if available to achieve both local control and elimination of potential micro metastases. Whereas there is evidence that surgery can cure localized prostate cancer, there are no clinical trials of multi-modal treatment of locally advanced prostate cancer that includes surgical removal of the prostate.
One potential advantage of adding prostatectomy to the treatment of LAPC is that removing the prostate enables a full pathological assessment of the tumor characteristics and thus a better estimation of the risk of recurrence. Surgical treatment could thus reduce the numbers needed to treat with chemotherapy and radiation, and thus improve quality of life after treatment. In addition, evidence indicate that residual cancer in the prostate occurs in 25% after radiation treatment (56) and surgical removal of the prostate may improve survival beyond what can be achieved by radiation and ADT. On the other hand, patients treated with surgery, radiation and hormones will experience side effects of all three treatment modalities and might fare better if radiotherapy plus hormones can provide oncological control without prior surgery.
A randomized clinical trial comparing two multimodal treatment regimens of which one includes a radical prostatectomy is therefore warranted.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Prostatectomy/Surgery Patients with locally advanced prostate adenocarcinoma recieves Prostatectomy/Surgery with or without adjuvant or salvage radiotherapy |
Procedure: Prostatectomy/Surgery
Radical prostatectomy with or without adjuvant or salvage radiotherapy
|
Active Comparator: Radiotherapy with adjuvant androgen deprivation therapy Patients with locally advanced prostate adenocarcinoma treated with adjuvant androgen deprivation therapy |
Other: Radiotherapy with adjuvant androgen deprivation therapy
Radiotherapy with adjuvant androgen deprivation therapy
|
Outcome Measures
Primary Outcome Measures
- Cause specific survival [Up to 10 years]
Cause-specific survival (CSS) will be calculated as "1-cause specific mortality. Mortality and mortality causes will be ascertained from the nationwide Cause-of-Death Register. In the absence of a functioning Cause-of-Death register, an endpoint committee of at least 2 medical doctors will determine the cause of death.
Secondary Outcome Measures
- Metastasis free survival [Up to 10 years]
Composite endpoint of time to metastasis and survival
- Quality of life - general psychological, urinary, bowel and sexual health [At 1,2,5 and 10 years after randomization]
Questionnaire-based evaluation of general psychological health, urinary health, bowel health, and sexual health. Questions about self Questions about quality of life in the past month (scale 1 to 7; 1=no quality, 7=the best quality) Depression and anxiety (scale 1 to 7; 1=no, 7=very) Symptom Form (EPIC-26) (scale 1 to 5; 1= no problem, 5=major problem) Questions about the urinary tract Questions about sexual function Questions about bowel function Questions about prostate cancer - diagnosis and treatment Questions about prostate cancer check-ups Questions about hormone/castration therapy and its significance Questions about pain and lymph swelling
- Overall survival [Up to 10 years]
Overall survival (OS) will be calculated as "1-overall mortality. Mortality data will be ascertained through the nationwide Cause-of-Death Register.
- Time to castration-resistant prostate cancer [Up to 10 years]
Ascertained at follow-up visits
- Time to biochemical progression [Up to 10 years]
Ascertained at follow-up visits
- Adverse events [Up to 10 years]
Ascertained at visits
- Cardiovascular disease [Up to 10 years]
Data from national PcBaSe-register (https://snd.gu.se/en/catalogue/study/ext0014), a registry where the national prostate cancer registry (NPCR, www.npcr.se) has been linked to the Swedish National Cancer Register, the Cause of Death Register, the Prescribed Drug Register, the National Patient Register, and the Acute Myocardial Infarction Register, the Register of the Total Population, the Longitudinal Integration database for health insurance and labour market studies (LISA), the Multi-Generatioon Register and several other population-based registers.
Other Outcome Measures
- Health-care consumption [Annually up to 10 years]
Annual Defined Daily Dose (DDD) of analgesics, prescription databases
- Health-care consumption [Annually up to 10 years]
Annual number of days of hospitalization from patient registers
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age ≤75, at the time of randomization
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Diagnosed histopathologically confirmed and untreated prostatic adenocarcinoma
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The general condition and mental status of patients shall permit observation in accordance with the study protocol
-
Tumor stage (T, M, N):
T3 stage (as indicated by digital rectal examination or MR imaging or other validated imaging technique) T4 tumors can be included if considered resectable/treatable on MR imaging Significant extra-capsular tumor extension in biopsy (rare but acceptable for inclusion) M0 (no sign of distant metastases) confirmed by bone scan or CT or MRT of axial skeleton (at a maximum of pelvis and lumbar vertebral column) N0 stage, defined in accordance to the RECIST guidelines as no sign of macroscopic retroperitoneal lymph-node metastases >=1.5 cm (short axis) on CT scan, PET-CT, or MRT or more than one suspected lymph-node metastases Presence Gleason grade pattern 4 or 5
- Signed Informed consent
Exclusion Criteria:
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Patients with a PSA value of > 100 ng/mL
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Any medical condition that, in the opinion of the investigator, might interfere with the evaluation of the study objectives Patients with contraindications for either prostatectomy or radiotherapy to the prostate are not eligible for the study. Most contraindications for these treatments are relative, but in general, radiotherapy may be precluded among patients with:
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Anorectal disease, such as fistulae, Crohn´s disease, and ulcerative colitis
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Significant obstructive lower urinary tract symptoms
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Proximal stricture of the urethrae
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Severe neurogenic bladder dysfunction
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Enlarged prostate beyond 70-90 ml
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Previous radiotherapy to the pelvic region
On the other hand, surgery may be precluded among patients with:
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Massive local tumor progression, particularly in the apical region
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Massive abdominal obesity
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Contraindications to anesthesia
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Aalborg University Hospital | Aalborg | Denmark | ||
2 | Aarhus University Hospital | Aarhus | Denmark | ||
3 | Rigshospitalet, Region h, Department Oncology | Copenhagen | Denmark | DK-2001 | |
4 | Rigshopsitalet Department urology | Copenhagen | Denmark | SE- 2001 | |
5 | Herlev Hospital | Herlev | Denmark | ||
6 | Odense University Hospital | Odense | Denmark | ||
7 | Helsinki University Hospital, Department of Urology | Helsinki | Finland | FIN-00290 | |
8 | Tampere University Hospital, Pihlajalinna Koskiklinikka | Tampere | Finland | ||
9 | Turku University Hospital | Turku | Finland | ||
10 | Sørlandet Hospital | Kristiansand | Norway | 4604 | |
11 | Oslo University Hospital, Department of radiation Therapy | Oslo | Norway | N-0424 | |
12 | Oslo University Hospital, Department Urology | Oslo | Norway | N-0424 | |
13 | University Hospital of North Norway | Tromsø | Norway | ||
14 | St. Olavs Hospital | Trondheim | Norway | ||
15 | Falu Lasarett | Falun | Sweden | SE 791 82 | |
16 | Sahlgrenska University Hospital | Göteborg | Sweden | SE-413 45 | |
17 | Helsingborgs Lasarett | Helsingborg | Sweden | SE 25187 | |
18 | Länssjukhuset Ryhov | Jönköping | Sweden | SE 553 05 | |
19 | Kirurgkliniken, Blekingesjukhuset | Karlskrona | Sweden | 371 41 | |
20 | Linköping University Hospital | Linköping | Sweden | ||
21 | Skåne University Hospital | Malmö | Sweden | SE 205 02 | |
22 | Vrinevis Hospital | Norrköping | Sweden | SE 601 82 | |
23 | Karolinska University Hospital | Stockholm | Sweden | SE 171 76 | |
24 | Capio St Göran Hospital | Stockholm | Sweden | ||
25 | Sundvalls Hospital | Sundsvall | Sweden | ||
26 | Umeå University Hospital | Umeå | Sweden | SE 901 87 | |
27 | Uppsala Akademiska Hospital | Uppsala | Sweden | SE 751 85 | |
28 | Centrallasarettet | Växjö | Sweden | SE 352 34 | |
29 | Centrallasarettet Växjö Hospital | Växjö | Sweden | ||
30 | Östersund Hospital | Östersund | Sweden | SE 831 31 |
Sponsors and Collaborators
- Olof Akre
Investigators
- Principal Investigator: Johan Stranne, M.D ass prof, Sahlgrenska University Hospital, Department of Urology, SE- 413 45 Gothenburg
- Principal Investigator: Camilla Thellenberg Karlsson, MD, PhD, Umeå University Hospital, Department of Radiation Science, SE-901 87 Umeå Sweden
- Principal Investigator: Eva M Johansson, R.N PhD, Karolinska Institute, Nobelsväg, SE- 171 77 Solna, Sweden
- Principal Investigator: Gunnar Steineck, M.D Prof, Karolinska Institute, Nobelsväg, SE-171 77 Solna, Sweden
- Principal Investigator: Klaus Brasso, M.D, Rigshospitalet, department Urology, DK-2001-Copenhagen, Denmark
- Principal Investigator: Peter M Meidahl Petersen, M.D ass prof, Rigshospitalet, Region h, Department of Oncology, Blegdamsvej 9, DK- 2001, Copenhagen, Denmark
- Principal Investigator: Bjørn Brennhovd, M.D ass.prof, Oslo University Hospital, Department of Urology, P.O Box 4950 Nydalen, N-0424, Oslo Norway
- Principal Investigator: Wolfgang Lilleby, M.D ass.prof, Oslo University Hospital, Department of Radiation Therapy, P.O Box 4950, N-0424, Nydalen Oslo, Norway
- Principal Investigator: Antti Rannikko, M.D ass.prof, Helsinki University Central Hospital, Department Urology,Stenbäckinkatu 9, FIN-00290 Helsinki , Finland
- Principal Investigator: Mauri Kouri, M.D PhD, Helsinki University Central Hospital, Department Urology,Stenbäckinkatu 9, FIN-00290 Helsinki , Finland
- Principal Investigator: Tuomas Mirtti, M.D PhD, Helsinki University Central Hospital, Department Urology,Stenbäckinkatu 9, FIN-00290 Helsinki , Finland
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- SPCG-15