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HDR Brachytherapy vs. LDR Brachytherapy Monotherapy in Localized Prostate Cancer (HDRvsLDR)

Primary Purpose

Prostate Cancer

Status

Completed

Phase

Phase 2

Locations

Canada

Study Type

Interventional

Intervention

Permanent Iodine-125 seed implant

High-Dose-rate Prostate Brachytherapy

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring High-Dose-Rate Brachytherapy, HDR Monotherapy, LDR monotherapy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

-Histologically confirmed adenocarcinoma of the prostate diagnosed within the last 9 months.

Patients on active surveillance with evidence of disease progression are eligible to the protocol as long as they meet the eligibility criteria and have a recent prostate biopsy (within 9 months).

Low-risk disease defined as: Clinical stage T1-T2 and Gleason 6 and PSA≤20 ng/mL.
Intermediate-risk disease defined as: Clinical stage T1-T2 and Gleason 7 (3+4) and PSA ≤ 20 ng/mL and ≤ 60% of positive cores.
Lymph node evaluation by either CT or MRI is optional and is left at the discretion of the treating physician.
No alpha reductase inhibitors use within 2 weeks of randomization. A washout period of 2 weeks is required prior to randomization.
Eastern Cooperative Oncology Group status 0-1
No hormonal therapy is accepted.
Prostate volume by Trans-rectal Ultrasound (TRUS) ≤ 60 cc.
Internation Prostate Symptom Score (IPSS) ≤ 20 (alpha blockers allowed)

Exclusion Criteria:

Patients with a history of other malignancies, except: adequately treated non-melanoma skin cancer, or other solid tumours curatively treated with no evidence of disease for ≥ 5 years.
Prior or current bleeding diathesis
Previous androgen deprivation therapy within 6 months of the registration.
Radical surgery for carcinoma of the prostate, prior pelvic radiation, prior chemotherapy for prostate cancer, prior Transurethral resection of the prostate (TURP), prior cryosurgery of the prostate.
Evidence of metastatic disease (radiology investigations at the discretion of the treating physician).
Any serious active or co-morbid medical conditions, laboratory abnormality, psychiatric illness, active or uncontrolled infections, or serious illnesses or medical conditions that would prevent the patient from participating or to be managed according to the protocol (according to investigator's decision).
Gleason score 7 (4+3), clinical stage≥ T3a, PSA > 20 and > 60% of positive cores.

Sites / Locations

CHU de Québec- L'Hôtel-Dieu de Québec

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Permanent Iodine-125 seed implant

High-dose-Rate Prostate brachytherapy

Arm Description

Prostate brachytherapy using Iodine-125 seed implant to a prescription dose of 144 Gy delivered to the Target volume defined as Clinical Target volume (CTV)+ 0-3 mm margin.

Prostate brachytherapy implant using Iridium-192 to a prescription dose of 19 Gy delivered to the CTV in one fraction. Greater than 95% coverage of the CTV with the prescription dose is considered per protocol, 90-95% coverage is considered a minor deviation and, < 90% coverage is considered a major deviation. Attempts should be made to achieve these other dosimetric values: D90: 105-115% V150 ≤ 35% V200 ≤ 12%

Outcomes

Primary Outcome Measures

Quality of Life differences at 3 months using the Expanded Prostate Cancer Index Composite in the urinary domain.

Secondary Outcome Measures

Quality of life differences using the Expanded Prostate Cancer Index Composite (EPIC) score in the bowel and sexual domain at baseline, 1, 3, 6, 12, and 24 months.

Differences in urinary function using the International Prostate Symptom Score which, will be filled in by the patient at baseline, 1, 3, 6, 12 and 24 months after the procedure.

Acute and long-term urinary, sexual and gastro-intestinal toxicity using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 at each patient's visit.

The dose to the bladder neck defined as 5 mm around the Foley catheter from the bottom of the Foley balloon to the prostatic urethra with a volume of at least 2 cc.

Local control by performing transrectal-ultrasound guided 12-core prostate rebiopsy at 36 months to assess treatment outcome.

The absolute PSA nadir value will be reported as a secondary objective by PSA measurements every 6 months after the procedure.

Patients will undergo a prostate biopsy at 36 months and the pathology will be reviewed by a Genito-urinary pathology expert and classified in 3 categories: negative (no evidence of cancer), positive ( persistence of cancer cells) and undetermined.

Full Information

NCT ID

NCT02628041

First Posted

December 7, 2015

Last Updated

February 8, 2021

Sponsor

CHU de Quebec-Universite Laval

Collaborators

Université de Montréal, Sunnybrook Health Sciences Centre

1. Study Identification

Unique Protocol Identification Number

NCT02628041

Brief Title

HDR Brachytherapy vs. LDR Brachytherapy Monotherapy in Localized Prostate Cancer

Acronym

HDRvsLDR

Official Title

A Phase II Randomized Trial Evaluating Acute and Late Toxicity of High-Dose Rate Brachytherapy and Low-Dose Rate Brachytherapy as Monotherapy in Localized Prostate Cancer

Study Type

Interventional

2. Study Status

Record Verification Date

February 2021

Overall Recruitment Status

Completed

Study Start Date

October 2015 (undefined)

Primary Completion Date

December 2017 (Actual)

Study Completion Date

February 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

CHU de Quebec-Universite Laval

Collaborators

Université de Montréal, Sunnybrook Health Sciences Centre

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

High-dose rate brachytherapy (HDRB) used as monotherapy is emerging as an alternative to Low-Dose Rate brachytherapy (LDRB) with excellent PSA-progression free survival as high as 90-100% for favorable prostate cancer at a median follow-up of 3-5 years. HDRB has many advantages over LDRB such as prospective dosimetry not impacted by setup errors, organ motion and prostate swelling during treatment delivery. In addition, HDRB causes less acute and late urinary toxicity compared with LDRB. Acute urinary retention can lead to prolonged catheterization, pericatheter urine leakage, urinary tract infection and Trans-Urethral Resection of the Prostate resulting in diminished quality of life (QOL) and increased psychological distress. The goal of the investigators' phase II randomized study is to evaluate the differences in QOL in the urinary domain between patients with favourable intermediate risk or extensive low-risk prostate cancer treated with LDRB and HDRB at 3 months using the Expanded Prostate Cancer Index Composite (EPIC) QOL scores. The 3 months cut-off endpoint has been chosen since HDRB-induced urinary toxicity subsides at 12 weeks compared to 12 months with LDRB. Secondary objectives include: bowel and sexual domain EPIC scores and International Prostate Symptom Score. The absolute PSA nadir and a prostate biopsy at 36 months will be reported to assess local control.

Detailed Description

Primary Endpoint: • To evaluate the differences in QOL in the urinary domain between patients treated with Low-Dose Rate Brachytherapy (LDRB) and High-Dose Rate Brachytherapy (HDRB) at 3 months. Secondary Endpoints: To compare LDRB vs. HDR as related to the Expanded Prostate Cancer Index Composite (EPIC) score in the bowel and sexual domain at baseline, 1, 3, 6, 12, and 24 months. To evaluate differences in urinary function using the IPSS which, will be filled in by the patient at baseline, 1, 3, 6, 12 and 24 months after the procedure. To report acute and long-term urinary, sexual and gastro-intestinal toxicity using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 at each patient's visit. To report the dose to the bladder neck defined as 5 mm around the Foley catheter from the bottom of the Foley balloon to the prostatic urethra with a volume of at least 2 cc. To assess local control by performing prostate rebiopsy after radiotherapy at 36 months to assess treatment outcome. The absolute Prostate Specific Antigen ( PSA) nadir value will be reported as a secondary objective by PSA measurements every 6 months after the procedure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Prostate Cancer

Keywords

High-Dose-Rate Brachytherapy, HDR Monotherapy, LDR monotherapy

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

30 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Permanent Iodine-125 seed implant

Arm Type

Active Comparator

Arm Description

Prostate brachytherapy using Iodine-125 seed implant to a prescription dose of 144 Gy delivered to the Target volume defined as Clinical Target volume (CTV)+ 0-3 mm margin.

Arm Title

High-dose-Rate Prostate brachytherapy

Arm Type

Experimental

Arm Description

Intervention Type

Radiation

Intervention Name(s)

Permanent Iodine-125 seed implant

Intervention Description

Permanent Iodine seed implant is performed under general or epidural anesthesia with the patient is positioned in the lithotomy position. A Foley catheter is inserted in the bladder. Under transrectal ultrasound guidance, the prostates is scanned and the dosimetry is generated. Catheters are inserted in the prostate and the seeds are injected using the Nucletron automatic after loader according to the dosimetry plan. The catheters are removed at the end of the procedure.

Intervention Type

Radiation

Intervention Name(s)

High-Dose-rate Prostate Brachytherapy

Other Intervention Name(s)

HDR implant

Intervention Description

High-Dose-Rate Prostate brachytherapy is performed under general or epidural anesthesia, the patient is positioned in the lithotomy position. A Foley catheter is inserted in the bladder. Under transrectal ultrasound guidance, catheters are inserted in the prostate to assure adequate coverage. The patient is returned in dorsal decubitus and a CT scan or Ultrasound scan is performed. A inverse-planning dosimetry plan is generated to deliver 19 Gy to the target volume. The patient is treated and then the implant is removed and anesthesia is reversed.

Primary Outcome Measure Information:

Title

Quality of Life differences at 3 months using the Expanded Prostate Cancer Index Composite in the urinary domain.

Time Frame

3 months

Secondary Outcome Measure Information:

Title

Quality of life differences using the Expanded Prostate Cancer Index Composite (EPIC) score in the bowel and sexual domain at baseline, 1, 3, 6, 12, and 24 months.

Time Frame

24 months

Title

Differences in urinary function using the International Prostate Symptom Score which, will be filled in by the patient at baseline, 1, 3, 6, 12 and 24 months after the procedure.

Time Frame

24 months

Title

Acute and long-term urinary, sexual and gastro-intestinal toxicity using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 at each patient's visit.

Time Frame

24 months

Title

The dose to the bladder neck defined as 5 mm around the Foley catheter from the bottom of the Foley balloon to the prostatic urethra with a volume of at least 2 cc.

Time Frame

1month

Title

Local control by performing transrectal-ultrasound guided 12-core prostate rebiopsy at 36 months to assess treatment outcome.

Time Frame

36 months

Title

The absolute PSA nadir value will be reported as a secondary objective by PSA measurements every 6 months after the procedure.

Description

Time Frame

every 6 months up to 5 years

10. Eligibility

Sex

Male

Minimum Age & Unit of Time

18 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: -Histologically confirmed adenocarcinoma of the prostate diagnosed within the last 9 months. Patients on active surveillance with evidence of disease progression are eligible to the protocol as long as they meet the eligibility criteria and have a recent prostate biopsy (within 9 months). Low-risk disease defined as: Clinical stage T1-T2 and Gleason 6 and PSA≤20 ng/mL. Intermediate-risk disease defined as: Clinical stage T1-T2 and Gleason 7 (3+4) and PSA ≤ 20 ng/mL and ≤ 60% of positive cores. Lymph node evaluation by either CT or MRI is optional and is left at the discretion of the treating physician. No alpha reductase inhibitors use within 2 weeks of randomization. A washout period of 2 weeks is required prior to randomization. Eastern Cooperative Oncology Group status 0-1 No hormonal therapy is accepted. Prostate volume by Trans-rectal Ultrasound (TRUS) ≤ 60 cc. Internation Prostate Symptom Score (IPSS) ≤ 20 (alpha blockers allowed) Exclusion Criteria: Patients with a history of other malignancies, except: adequately treated non-melanoma skin cancer, or other solid tumours curatively treated with no evidence of disease for ≥ 5 years. Prior or current bleeding diathesis Previous androgen deprivation therapy within 6 months of the registration. Radical surgery for carcinoma of the prostate, prior pelvic radiation, prior chemotherapy for prostate cancer, prior Transurethral resection of the prostate (TURP), prior cryosurgery of the prostate. Evidence of metastatic disease (radiology investigations at the discretion of the treating physician). Any serious active or co-morbid medical conditions, laboratory abnormality, psychiatric illness, active or uncontrolled infections, or serious illnesses or medical conditions that would prevent the patient from participating or to be managed according to the protocol (according to investigator's decision). Gleason score 7 (4+3), clinical stage≥ T3a, PSA > 20 and > 60% of positive cores.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Lara Hathout, MD, FRCPC

Organizational Affiliation

Centre Hospitalier Universitaire du CHU de Québec

Official's Role

Principal Investigator

Facility Information:

Facility Name

CHU de Québec- L'Hôtel-Dieu de Québec

City

Québec

State/Province

Quebec

ZIP/Postal Code

G1R 2J6

Country

Canada

12. IPD Sharing Statement

Plan to Share IPD

Undecided

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HDR Brachytherapy vs. LDR Brachytherapy Monotherapy in Localized Prostate Cancer

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