Adenocarcinoma of the Prostate
Conditions
Keywords
Prostate Cancer, Radiotherapy, Androgen Deprivation
Brief summary
We hypothesize that Stereotactic Body Radiotherapy Boost (SBRT) as a boost to the prostate following whole pelvic intensity modulated radiotherapy (IMRT) can be delivered effectively and safely in a population of men with unfavorable intermediate and high risk localized prostate cancer. Our primary objective is to assess the feasibility and safety of a treatment strategy incorporating whole pelvic IMRT followed by an SBRT boost to the prostate with neoadjuvant, concurrent, and adjuvant androgen deprivation for a total of 28 months for men with unfavorable intermediate or high risk localized prostate cancer.
Detailed description
The primary objective of this study is to assess the feasibility and safety of a treatment strategy incorporating whole pelvic IMRT followed by an SBRT boost to the prostate with neoadjuvant, concurrent, and adjuvant androgen deprivation for a total of 28 months for men with unfavorable intermediate or high risk localized prostate cancer. The secondary objective is to assess biochemical control at 24 months following the experimental treatment strategy by the Phoenix definition. Patients not meeting these prostate-specific antigen (PSA) criteria (Phoenix Definition) for failure who undergo salvage therapies (such as androgen deprivation therapy (ADT), radical prostatectomy or brachytherapy, or Cryosurgery) should also be declared as failures at the time a positive biopsy is obtained or salvage therapy is administered, whichever comes first. Another secondary objective is to assess toxicity of the experimental treatment approach as scored by the Common Terminology Criteria for Adverse Events The third secondary objective is to assess prostate organ motion during hypofractionated radiotherapy. To assess motion of the prostate during the protracted delivery of hypofractionated radiotherapy as assessed by implanted electromagnetic transponder beacons.
Interventions
RADIATIONStereotactic Radiosurgical Boost
Intensity Modulated Radiotherapy (IMRT)2 with Concurrent Androgen Blockade to Whole Pelvis, Prostate, and Seminal Vesicles Followed by: Stereotactic Radiosurgical Boost3 to the Prostate with Implanted Electromagnetic Transponder Beacon Intrafraction Guidance
DRUGCasodex
Neoadjuvant Androgen Blockade before radiation therapy and Adjuvant Androgen Blockade after radiation therapy
DRUGLeuprolide
Neoadjuvant Androgen Blockade before radiation therapy and Adjuvant Androgen Blockade after radiation therapy
Sponsors
University of California, Davis
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Pathologically (histologically or cytologically) proven diagnosis of prostatic adenocarcinoma within 180 days of registration at moderate to high risk for recurrence 2. History/physical examination (to include at a minimum digital rectal examination of the prostate and examination of the skeletal system and abdomen) within 90 days prior to registration. 3. Clinically negative lymph nodes as established by imaging (pelvic ± abdominal CT or MRI), (but not by nodal sampling, or dissection) within 90 days prior to registration. 4. Patients with lymph nodes equivocal or questionable by imaging are eligible if the nodes are ≤ 2.0 cm. 5. No evidence of bone metastases (M0) on bone scan within 90 days prior to registration. 6. Equivocal bone scan findings are allowed if plain films (or CT or MRI) are negative for metastasis. 7. Baseline serum PSA value performed with an FDA-approved assay (e.g., Abbott, Hybritech) within 12 weeks (90 days) prior to registration. 8. Study entry PSA should not be obtained during the following time frames: (1) 10-day period following prostate biopsy; (2) following initiation of hormonal therapy; (3) within 30 days after discontinuation of finasteride; (4) within 90 days after discontinuation of dutasteride. 9. Zubrod Performance Status 0-2 10. Complete blood count (CBC)/differential obtained within 2 weeks (14 days) prior to registration on study, with adequate bone marrow function 11. Patient must be able to provide study specific informed consent prior to study entry.
Exclusion criteria
1. Prior invasive (except non-melanoma skin cancer) malignancy unless disease-free for a minimum of 2 years. 2. Previous radical surgery (prostatectomy) or cryosurgery for prostate cancer 3. Previous pelvic irradiation, prostate brachytherapy, or bilateral orchiectomy 4. Previous hormonal therapy 5. Prior pharmacologic androgen ablation for prostate cancer is allowed only if the onset of androgen ablation is ≤ 60 days prior to the date of registration. 6. Use of finasteride within 30 days prior to registration 7. Use of dutasteride or dutasteride/tamsulosin (Jalyn) within 90 days prior to registration 8. Previous or concurrent cytotoxic chemotherapy for prostate cancer; note that prior chemotherapy for a different cancer is allowable. See Section 3.2.1. 9. Prior radiotherapy, including brachytherapy, to the region of the study cancer that would result in overlap of radiation therapy fields 10. Severe, active co-morbidity including heart issues, infection and liver problems 11. Patients who are sexually active and not willing/able to use medically acceptable forms of contraception 12. Prior allergic reaction to the hormones involved in this protocol 13. Patients status-post a negative lymph node dissection are not eligible
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tumor Assessment | 24 months | Tumors will be assessed using the American Joint Committee on Cancer (AJCC) Staging System, 7th Edition. This system consists of the following subscales: the extent of the primary tumor (T category), whether the cancer has spread to nearby lymph nodes (N category), the absence or presence of distant metastasis (M category), the PSA level at the time of diagnosis, and the Gleason score, based on the prostate biopsy (or surgery). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Zubrod Performance Scale | Weekly during radiation treatment; every three months during hormone therapy; every six months for 3 yrs after hormone therapy | This is a scale used to evaluate the patient's performance status is an attempt to quantify cancer patients' general well-being and activities of daily life. |
Countries
United States
Outcome results
None listed