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Phase II High Dose Brachytherapy and Low Dose Rate Brachytherapy as Monotherapy in Localized Prostate Cancer

Primary Purpose

Prostate Carcinoma

Status
Recruiting
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Low dose rate brachytherapy
High dose rate brachytherapy
Sponsored by
Canadian Cancer Trials Group
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Carcinoma

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).
  • Patients with low or intermediate risk prostate cancer are eligible according to the following guidelines:

    • TNM classification:

    • Clinical stage T1-T2 and Gleason 6 and PSA <20 ng/mL (Low risk)
    • Clinical stage T1-T2 and Gleason 7 (3+4) and PSA < 15 ng/mL and ≤ 50% of positive cores (Intermediate risk)
  • Eastern Cooperative Oncology Group status 0-1.
  • Bone scan and pelvic CT scan/MRI within the last 6 months at the discretion of the treating physician.
  • Patient must be ≥ 18 years of age.
  • Judged to be medically fit for brachytherapy.
  • Prostate volume by Trans-rectal Ultrasound (TRUS) or Magnetic Resonance Imaging (MRI) ≤ 60 cc within the last 6 months.
  • American Urological Association (AUA) score ≤ 20 (alpha blockers allowed) within the last 4 weeks.
  • Patient is able (i.e. sufficiently fluent) and willing to complete the quality of life questionnaires in either English or French.
  • Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements. Each patient must sign a consent form prior to enrolment in the trial to document their willingness to participate.
  • Patients must be accessible for treatment and follow-up. Patients registered on this trial must be treated and followed at the participating centre.
  • In accordance with CCTG policy, protocol treatment is to begin within 12 weeks of patient randomization.
  • Patients must be willing to take precautions to prevent pregnancy while on study.
  • Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.

Exclusion Criteria:

  • Prior or current bleeding diathesis.
  • Previous androgen deprivation therapy (ADT).
  • Alpha-reductase inhibitors (ARIs) within 90 days of randomization.
  • Radical surgery for carcinoma of the prostate, prior pelvic radiation, prior chemotherapy for prostate cancer, prior 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).

Sites / Locations

  • Ottawa Hospital Research InstituteRecruiting
  • Odette Cancer CentreRecruiting
  • University Health NetworkRecruiting
  • CHUM-Centre Hospitalier de l'Universite de MontrealRecruiting
  • The Jewish General HospitalRecruiting
  • Hotel-Dieu de QuebecRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Arm 1 LDR

Arm 3 HDR

Arm Description

Low Dose Rate (LDR) brachytherapy with I-125 to a total dose of 144 Gy

High Dose Rate brachytherapy: 27 Gy in 2 fractions

Outcomes

Primary Outcome Measures

Efficacy of HDR and LDR brachytherapy on prostate cancer control as defined by 48 month PSA values
The primary endpoint of the study is prostate cancer control rate at 48 months. It is defined as the PSA <0.4ng/ml at 48 months. One sample binomial test will be used to test the 48 months disease control rate for each arm

Secondary Outcome Measures

Disease-free survival
Number and severity of adverse events
Acute and long term toxicity and safety including lower urinary tract symptoms
Quality of Life of patient and partner utilizing EPIC, PROMIS and R-DAS fatigue short form
Economic Analysis
Resource utilization and economic indices of treatment administration

Full Information

First Posted
November 7, 2016
Last Updated
October 3, 2023
Sponsor
Canadian Cancer Trials Group
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1. Study Identification

Unique Protocol Identification Number
NCT02960087
Brief Title
Phase II High Dose Brachytherapy and Low Dose Rate Brachytherapy as Monotherapy in Localized Prostate Cancer
Official Title
A Randomized Phase II Trial Evaluating High Dose Rate Brachytherapy and Low Dose Rate Brachytherapy as Monotherapy in Localized Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 6, 2017 (Actual)
Primary Completion Date
September 30, 2027 (Anticipated)
Study Completion Date
March 31, 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Canadian Cancer Trials Group

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the dose of High Dose Rate (HDR) brachytherapy chosen for this study as well as a commonly used alternate form of brachytherapy called low dose rate (or seed) brachytherapy. Investigators would like to understand how these treatments control the prostate cancer and look at their short and long term treatment related side effects. The dose of radiation for HDR brachytherapy for this study has been changed since the study started. Other studies using the dose of radiation for HDR brachytherapy that was originally chosen for this study (Arm 2) found that this dose of radiation may be linked to a greater chance of the cancer coming back in the prostate. Therefore since March 2020, for new participants entering the study, a new HDR brachytherapy arm with a higher amount of radiation given over two doses will be tested in this study
Detailed Description
Radiation therapy is an accepted treatment to help manage low and intermediate risk prostate cancer. Radiation therapy can be given using machines that are outside the body (called "image guided external beam radiation therapy") or by brachytherapy, which is a form of radiation therapy where the radiation source is placed directly into the prostate gland near the tumour. The standard or usual treatments for low or intermediate risk prostate cancer are low dose-rate (LDR) brachytherapy which involves placing radioactive seeds in the prostate which deliver radiation over several months, image guided external beam radiation therapy (IGRT), or IGRT plus high dose-rate (HDR) brachytherapy boost. High Dose-Rate (HDR) brachytherapy is another type of brachytherapy which delivers a high dose of radiation to the tumour over a period of minutes. The radiation is delivered under computer control through flexible needles, which are temporarily inserted into the prostate. This form of radiotherapy targets cancer cells within the prostate gland. HDR brachytherapy is another type of radiotherapy for prostate cancer that has the potential to help target your cancer more accurately while causing fewer side effects compared with standard radiation therapy. HDR brachytherapy is an option for treatment in some hospitals now but the best dose of radiation is still unknown. This study is testing a new dose of radiation for HDR brachytherapy.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
232 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 LDR
Arm Type
Active Comparator
Arm Description
Low Dose Rate (LDR) brachytherapy with I-125 to a total dose of 144 Gy
Arm Title
Arm 3 HDR
Arm Type
Active Comparator
Arm Description
High Dose Rate brachytherapy: 27 Gy in 2 fractions
Intervention Type
Radiation
Intervention Name(s)
Low dose rate brachytherapy
Intervention Description
I-125 to a total dose of 144 Gy
Intervention Type
Radiation
Intervention Name(s)
High dose rate brachytherapy
Intervention Description
27 Gy in 2 fractions
Primary Outcome Measure Information:
Title
Efficacy of HDR and LDR brachytherapy on prostate cancer control as defined by 48 month PSA values
Description
The primary endpoint of the study is prostate cancer control rate at 48 months. It is defined as the PSA <0.4ng/ml at 48 months. One sample binomial test will be used to test the 48 months disease control rate for each arm
Time Frame
48 months
Secondary Outcome Measure Information:
Title
Disease-free survival
Time Frame
7 years
Title
Number and severity of adverse events
Description
Acute and long term toxicity and safety including lower urinary tract symptoms
Time Frame
7 years
Title
Quality of Life of patient and partner utilizing EPIC, PROMIS and R-DAS fatigue short form
Time Frame
7 years
Title
Economic Analysis
Description
Resource utilization and economic indices of treatment administration
Time Frame
7 years
Other Pre-specified Outcome Measures:
Title
Establish a comprehensive tumour bank linked to a clinical database for further studies of predictive and prognostic biomarkers in prostate cancer
Time Frame
7 years
Title
PSA Progression - PSA nadir +2 ng/ml will be used to define biochemical failure and can only be declared at 36 months or beyond due to the phenomenon of PSA bounce
Time Frame
7 years
Title
PSA nadir - Date PSA nadir +2 ng/ml is reached
Time Frame
7 years
Title
Local disease progression - Clinically suspicious change in DRE with biopsy confirmation of progression or Urethral obstruction or bleeding necessitating a trans-urethral resection (TURP) only if resected tissue demonstrates malignancy
Time Frame
7 years
Title
Regional disease progression - Prostate cancer progression involving the lymph nodes below the bifurcation of the common iliac arteries.
Time Frame
7 years
Title
Distant disease progression - Evidence of prostate cancer by radiology or cytology or histology at sites remote from the prostate
Time Frame
7 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
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). Patients with localized prostate cancer are eligible according to the following guidelines: • TNM classification: Clinical stage T1-T2 and Gleason 6 and PSA <20 ng/mL Clinical stage T1-T2 and Gleason 7 (3+4) and PSA < 15 ng/mL and ≤ 50% of positive nontargeted cores in patients who undergo systematic biopsy Eastern Cooperative Oncology Group status 0-1. Bone scan and pelvic CT scan/MRI within the last 6 months at the discretion of the treating physician. Patient must be ≥ 18 years of age. Judged to be medically fit for brachytherapy. Prostate volume by Trans-rectal Ultrasound (TRUS) or Magnetic Resonance Imaging (MRI) ≤ 60 cc within the last 6 months. American Urological Association (AUA) score ≤ 20 (alpha blockers allowed) within the last 4 weeks. Patient is able (i.e. sufficiently fluent) and willing to complete the quality of life questionnaires in either English or French. Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements. Each patient must sign a consent form prior to enrolment in the trial to document their willingness to participate. Patients must be accessible for treatment and follow-up. Patients registered on this trial must be treated and followed at the participating centre. In accordance with CCTG policy, protocol treatment is to begin within 12 weeks of patient randomization. Patients must be willing to take precautions to prevent pregnancy while on study. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial. Exclusion Criteria: Prior or current bleeding diathesis. Previous androgen deprivation therapy (ADT). Alpha-reductase inhibitors (ARIs) within 90 days of randomization. Radical surgery for carcinoma of the prostate, prior pelvic radiation, prior chemotherapy for prostate cancer, prior 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).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wendy Parulekar
Phone
613-533-6430
Email
wparulekar@ctg.queensu.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gerard Morton
Organizational Affiliation
Sunnybrook Health Sciences, Toronto ON
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Eric Vigneault
Organizational Affiliation
Hotel Dieu de Quebec, Montreal, QC
Official's Role
Study Chair
Facility Information:
Facility Name
Ottawa Hospital Research Institute
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1H 8L6
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alain Haddad
Phone
613 737-7700
Ext
25395
Facility Name
Odette Cancer Centre
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4N 3M5
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gerard Morton
Phone
416 480-6165
Facility Name
University Health Network
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Srinivas Raman
Phone
416 946-4501
Facility Name
CHUM-Centre Hospitalier de l'Universite de Montreal
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H2X 3E4
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maroie Barkati
Phone
514 890-8254
Facility Name
The Jewish General Hospital
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3T 1E2
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M. Tamim Niazi
Phone
514 340-8288
Facility Name
Hotel-Dieu de Quebec
City
Quebec City
State/Province
Quebec
ZIP/Postal Code
G1R 2J6
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Eric Vigneault
Phone
418 691-5264

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Phase II High Dose Brachytherapy and Low Dose Rate Brachytherapy as Monotherapy in Localized Prostate Cancer

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