Modifications to Radical Prostatectomy: Feasibility Study

Memorial Sloan Kettering Cancer Center (MSK)

Status

Completed

Conditions

Prostate Cancer

Treatments

Procedure: radical prostatectomy with neither urethral irrigation nor fascial suturing, QOL forms

Procedure: radical prostatectomy with both urethral irrigation and fascial suturing, QOL forms

Procedure: radical prostatectomy with urethral irrigation but no fascial suturing, QOL forms

Procedure: radical prostatectomy with fascial suturing but no urethral irrigation, QOL forms

Study type

Interventional

Funder types

Other

Identifiers

NCT00928850

09-051

Details and patient eligibility

About

This study aims to determine whether surgeons at Memorial Sloan-Kettering Cancer Center are able to randomize patients to test modifications of surgery to remove the prostate. Surgery to remove the prostate is known as a "radical prostatectomy". Surgeons know many things about the best way to do a radical prostatectomy. However, there is disagreement about some aspects of surgery. Two modifications of surgery to remove the prostate (radical prostatectomy) identified for this study include Irrigation, and Fascial Suturing.

Two aspects of the operation may vary, fascial suturing and urethral irrigation. For each aspect, surgeons will use their clinical judgment as to the best interests of the patient. In other words, if there are clear reasons to use or avoid a fascial suturing approach, the surgeon will act accordingly; similarly, if there is a clear reason to irrigate or avoid irrigating the urethra, the surgeon can make the appropriate clinical decision. If the surgeon is unsure as to which approach to take, then the randomization scheme will be followed.

All of the surgeons who are taking part in this study have used these techniques at different times. However, they are unsure as to the best approach. Sometimes, they use different treatments with different patients.

Irrigation. Cancer cells can spill during surgery and this can cause cancer to return ("recur"). Some surgeons believe that "irrigating" could help stop spilling of cancer cells. "Irrigating" means washing the surgical area with sterile water and sucking the water back up through a tube. As a result, surgeons vary as to how they irrigate. In this study, we will examine irrigation of the urethra. This is the part of the body that carries urine from the bladder to the penis.

Fascial suturing. Surgeons believe that what happens to the urethra can affect the risk of incontinence. This is when a patient cannot control urine, and drips or leaks urine. One idea is that additional stitches ("sutures") to the connective tissue ("fascia") could be helpful, but this is not known for sure.

Enrollment

154 patients

Sex

Male

Ages

21+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Patients scheduled for radical prostatectomy for the treatment of prostate cancer with one of the consenting surgeons at MSKCC.

Exclusion criteria

Prior treatment for prostate cancer: radiation, hormonal therapy, chemotherapy or focal therapy.

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

154 participants in 4 patient groups

urethral irrigation but no fascial suturing, QOL forms

Active Comparator group

Description:

The anterior two-thirds of the urethra is divided exposing a Foley catheter that was placed at the beginning of the procedure. Irrigation of the urethra may prevent spread of prostate cancer cells to tissue that is not removed during surgery. The urethra is irrigated with 60 cc of sterile water as it is withdrawn from the patient to 'wash' the urethra.

Treatment:

Procedure: radical prostatectomy with urethral irrigation but no fascial suturing, QOL forms

fascial suturing but no urethral irrigation, QOL forms

Active Comparator group

Description:

For patients undergoing fascial suturing only, after the initial placement of the suture through the urethra a second bite is taken deeply into the fascia of the lateral pelvic fascia.

Treatment:

Procedure: radical prostatectomy with fascial suturing but no urethral irrigation, QOL forms

both urethral irrigation and fascial suturing, QOL forms

Active Comparator group

Treatment:

Procedure: radical prostatectomy with both urethral irrigation and fascial suturing, QOL forms

neither urethral irrigation nor fascial suturing, QOL forms

Active Comparator group

Treatment:

Procedure: radical prostatectomy with neither urethral irrigation nor fascial suturing, QOL forms