Radical Retropubic Prostatectomy Versus Conventional External Beam Radiotherapy for Clinically Localized Prostate Cancer

University of Rome Tor Vergata

Status and phase: Suspended; Phase 3

Conditions: Prostate Cancer

Treatments: Procedure: Radical retropubic prostatectomy; Radiation: External beam radiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT02091661

UTV55/96

Details and patient eligibility

About

The purpose of this study is to evaluate the effectiveness of the two most established primary treatments for patients with clinically localized prostate cancer: radical retropubic prostatectomy, and external-beam radiotherapy. The primary aim is assessing biochemical disease-free survival, overall survival, and prostate cancer-specific survival. As secondary objectives quality of Life impact of treatments' side effects will be also assessed.

Full description

Eligible patients had clinically localized (clinical TNM classification T1 or T2), biopsy-proven adenocarcinoma of the prostate and were randomly treated with RRP or EBRT. Exclusion criteria included prior treatment for prostate cancer, the presence of metastatic disease on imaging studies, the receipt of neoadjuvant androgen ablation before registration, and an inability to read or understand Italian language. The institutional review boards of every participating centre approved the study design. Every patient enrolled signed an informed-consent form approved by the institutional review boards. Clinical information collected from the medical record included pre-treatment serum prostate-specific antigen (PSA) level, clinical T classification, and biopsy Gleason score. Follow-up assessments were completed before treatment and every 3 months after treatment. Subjects who sought primary treatment elsewhere or did not return follow-up questionnaires beyond the initial assessment were excluded from this analysis.

Enrollment: 500 estimated patients

Sex: Male

Ages: Under 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 75 years or younger
• Diagnosis of prostate cancer, as verified by cytologic or histologic examination the tumor is well differentiated to moderately well differentiated
• Untreated, clinically localized prostate cancer, with a tumor stage of T1, or T2
• Prostate specific antigen (PSA) level of ≤10 ng/ml
• Bone scan with no abnormalities
• Health status that would permit radical prostatectomy
• Life expectancy of more than 10 years.

Exclusion criteria

• PSA >10 ng/ml
• Bone scan consistent with metastatic disease
• Other evidence that cancer of the prostate is not clinically localized
• Life expectancy less than 10 years
• Serum creatinine greater than 3 mg/dl
• Myocardial infarction within last 6 months
• Unstable angina Class III or IV
• Severe pulmonary disease
• Liver failure
• Severe dementia
• Debilitating illness Malignancies, except for nonmelanomatous skin cancer, in the last 5 years.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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500 participants in 2 patient groups

Radical retropubic prostatectomy

Active Comparator group

Description:

The surgery arm underwent radical retropubic prostatectomy, performed by a technique described by Walsh.surgery started with dissection of the pelvic lymph nodes. If there were no signs of metastasis in frozen sections, the operation was continued with retropubic radical prostatectomy. The prostatectomy is performed in retrograde way, preserving the neurovascular bundles if feasible. The degree to which the surgeon preserve the nerves is categorized as non-nerve-sparing, unilateral nerve-sparing, or bilateral nerve-sparing.The operative time is about 2 to 3 hours and required hospital stay. The patient has a urinary catheter placed for 6 to 9 days to facilitate bladder emptying.

Treatment:

Procedure: Radical retropubic prostatectomy

External beam radiotherapy

Active Comparator group

Description:

External beam radiotherapy is carried out with intensity-modulated radiation technique. The treatment is designed to maximize the radiation dose to the prostate and seminal vesicles and minimize exposure to surrounding structures, including the bladder and rectum. Radiation to the prostate was delivered in fractionated doses divided over multiple treatments (180 to 200 centigray (cGy) daily fractions, 5 days per week) for a total dose to the prostate of 68 to 77 gray (Gy), prescribed at 90% to 100% of the isodose line.

Treatment:

Radiation: External beam radiotherapy