Cytoreductive Prostatectomy Versus Cytoreductive Prostate Irradiation as a Local Treatment Option for Metastatic Prostate Cancer: a Multicentric Feasibility Trial

Overview

According to the guidelines of the European Association of Urology (EAU), the first-line treatment for newly diagnosed mPC consists of immediate castration with the addition of docetaxel or abiraterone acetate. As seen in other well-known solid tumours – such as ovarian, colon and renal cancer – local treatment (LT) of the primary tumour could lead to a survival benefit compared to standard of care (SOC). Several retrospective studies have suggested a survival benefit of local treatment of the primary tumour with SOC versus SOC only in mPC. These patients also have less local symptoms of their disease, which has a major impact on quality of life (QoL). Several prospective studies have already been set up to compare either surgery or radiotherapy with the SOC. In expectation of their results and because randomization seems challenging, the investigators want to set up a trial to evaluate the feasibility of randomization between both local treatment groups.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: August 1, 2020

Interventions

  • Procedure: radical prostatectomy
    • can be performed either open, laparoscopic or robot-assisted, which is chosen by the discretion and expertise of the performing surgeon
  • Radiation: Whole pelvis radiotherapy
    • radiation of prostate bed and pelvis

Arms, Groups and Cohorts

  • Experimental: Radical prostatectomy
  • Experimental: Radiotherapy

Clinical Trial Outcome Measures

Primary Measures

  • Feasibility of randomization between both treatment arms as assessed by the randomized proportion
    • Time Frame: 48 months
    • In this trial we want to assess whether it is feasible to randomize patients into both treatment arms. All patients eligible for inclusion will be reported. The eventual proportion of randomized patients will be evaluated. Reasons for exclusion will be monitored.

Secondary Measures

  • castration-resistant free survival
    • Time Frame: 48 months
    • Calculated starting from date of randomization until castration-resistant disease development, as defined by the European Association of Urology (EAU) guidelines

Participating in This Clinical Trial

Inclusion Criteria

  • Male ≥18y – Histologically proven PC – Newly diagnosed metastatic PC as assessed by standard imaging (CT and bone scintigraphy) – ECOG 0-1 (2 if related to local PC symptoms) – Eligible for local treatment – Written informed consent and able and willing to comply with protocol requirements Exclusion Criteria:

  • Previous systemic treatment for PC except ADT started within 3 months before randomization – Previous radiotherapy to the pelvis interfering with prostate irradiation – Previous surgery in the pelvis interfering with radical prostatectomy – Symptoms related to metastatic lesions, persisting for at least 2 weeks after initiation of ADT – Metastatic brain disease, leptomeningeal disease or imminent spinal cord compression – Previous or current malignant disease which is likely to interfere with LoMP II treatment or assessment – Psychological disorder intervening with understanding the information or the informed consent

Gender Eligibility: Male

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University Hospital, Ghent
  • Provider of Information About this Clinical Study
    • Sponsor

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