Erythropoietin to Enhance Recovery of Erectile Function in Men Following Radical Prostatectomy

Johns Hopkins University56 enrolled

Overview

This research study aims to explore the effectiveness of human erythropoietin versus placebo in promoting the recovery of erectile function in patients undergoing bilateral nerve-sparing radical retropubic prostatectomy for clinically localized prostate cancer. Pre-clinical studies have shown erythropoietin potently promoted recovery of erectile function in rats and humans have similar receptors on penile tissues and the periprostatic neurovascular bundles. A clinical non-randomized study conducted in men undergoing radical prostatectomy demonstrated a benefit to recovery of erectile function. Therefore, the hypothesis is that erythropoietin offers nerve protection in men undergoing nerve-sparing radical prostatectomy and results in a reduced degree of erectile dysfunction and also an improved rate of erection recovery following surgery.

This study will evaluate the effectiveness of erythropoietin versus placebo in the recovery of erectile function in patients undergoing bilateral nerve-sparing radical prostatectomy for prostate cancer. Recent laboratory findings in rat models and on human urogenital tissues suggest that erythropoietin may play a role in protection of the cavernous nerves during surgery. Some degree of nerve trauma occurs during bilateral nerve-sparing radical prostatectomy, but for most it is temporary. Erythropoietin will be studied as an investigational drug for enhancement of erectile function postoperatively in a prospective, randomized study. Erythropoietin has been used in many men undergoing open radical prostatectomy in the past according to FDA indications for preparation for noncardiac, nonvascular surgery with a high risk of blood loss. Evidence also suggests it is safe with no demonstration of increased risk of venous thromboembolism (blood clots) or cardiac events for men with prostate cancer undergoing radical prostatectomy. The length of the study is 12 months and involves receiving a dose of study drug or placebo on the day before surgery, the day of surgery, and the day following surgery. The dose is given by subcutaneous injection. The study will also require the completion of questionnaires which will be completed online every three months until study completion (at 3, 6, 9, and 12 months) to assess outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

Eligibility

Sex: MALEMin age: 40 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patient eligibility consists of men 40 to 65 years of age * Localized prostate cancer * clinical stage T2a or lower * Gleason grade of 3+4 or 3+3 * prostate specific antigen (PSA) \< 10 * Scheduled to undergo curative prostatectomy applying bilateral nerve-sparing procedure, with intact pre-surgical erectile function * International Index of Erectile Function-5 (IIEF-5) score of 22-25. * The patient has a sexual partner, of at least 6 months. * The patient's pre-surgical hematocrit is ≤ 48. * The patient is willing to attempt intercourse at least 5 times per month following recovery from surgery. Exclusion Criteria: * The patient has known penile deformity or a history of Peyronie's disease. * The patient has planned pre or post operative androgen therapy. * The patient has planned pre or post operative radiation therapy. * The patient is on anticoagulation therapy. * The patient has a history of sickle cell anemia. * The patient has a history of high or low blood pressure that is not controlled. * The patient is taking medications called "nitrates" * The patient has a history of heart problems such as angina, heart failure, irregular heartbeats, or myocardial infarction * The patient has a history of history of drug or alcohol abuse. * The patient currently smokes or has a 20 pack/year history of cigarette smoking. * The patient has a history of acute or chronic depression * The patient has a history liver problems, or kidney problems. * The patient has a history of retinitis pigmentosa or severe vision loss, including a condition called NAION, Nonarteritic Anterior Ischemic Optic Neuropathy. * The patient has a history of spinal trauma or surgery to the brain or spinal cord. * The patient has contraindications to the use of phosphodiesterase type 5 (PDE 5) inhibitors. * Patient is currently participating in another clinical investigation that would serve as a contraindication to administering erythropoietin.

Outcomes

Primary Outcomes

Erectile Function as Assessed by the International Index of Erectile Function (IIEF) Questionnaire Erectile Function Domain

Survey measuring erectile function using the IIEF (erectile function domain only) with overall score ranging from 0 to 30 where higher scores represent better erectile function.

Time frame: At 6 months post-surgery

Secondary Outcomes

Erectile Function as Assessed by the IIEF Questionnaire Erectile Function Domain

Survey measuring erectile function using the IIEF (erectile function domain only) with overall score ranging from 0 to 30 where higher scores represent better erectile function.

Time frame: At 3 months post-surgery

Erectile Function as Assessed by the IIEF Questionnaire Erectile Function Domain

Survey measuring erectile function using the IIEF (erectile function domain only) with overall score ranging from 0 to 30 where higher scores represent better erectile function.

Time frame: At 9 months post-surgery

Erectile Function as Assessed by the IIEF Questionnaire Erectile Function Domain

Survey measuring erectile function using the IIEF (erectile function domain only) with overall score ranging from 0 to 30 where higher scores represent better erectile function.

Time frame: At 12 months post-surgery

Patient Score on the Overall IIEF Questionnaire

Survey measuring erectile function using the IIEF (overall questionnaire) with overall score ranging from 0 to 75 where higher scores represent better erectile function.

Time frame: At 3 months post-surgery

Patient Score on the Overall IIEF Questionnaire

Survey measuring erectile function using the IIEF (overall questionnaire) with overall score ranging from 0 to 75 where higher scores represent better erectile function.

Time frame: At 6 months post-surgery

Patient Score on the Overall IIEF Questionnaire

Survey measuring erectile function using the IIEF (overall questionnaire) with overall score ranging from 0 to 75 where higher scores represent better erectile function.

Time frame: At 9 months post-surgery

Patient Score on the Overall IIEF Questionnaire

Survey measuring erectile function using the IIEF (overall questionnaire) with overall score ranging from 0 to 75 where higher scores represent better erectile function.

Time frame: At 12 months post-surgery

Patient Score on Health-related Quality of Life Questionnaires (SF-12 MCS)

Mental health composite score (MCS) component of the 12-Item Short Form Survey Instrument (SF-12) measured on a normalized scale with mean 50 and standard deviation 10 in the United States population. Higher scores represent a higher level of mental health.

Time frame: At 3 months post-surgery

Patient Score on Health-related Quality of Life Questionnaires (SF-12 MCS)

Time frame: At 6 months post-surgery

Patient Score on Health-related Quality of Life Questionnaires (SF-12 MCS)

Time frame: At 9 months post-surgery

Patient Score on Health-related Quality of Life Questionnaires (SF-12 MCS)

Time frame: At 12 months post-surgery

Patient Score on the Expanded Prostate Cancer Index Composite (EPIC) Sexual Domain

Sexual health domain score of the EPIC survey measuring health-related quality of life with higher scores representing better sexual function on a scale of 0 to 100.

Time frame: At 3 months post-surgery

Patient Score on the Expanded Prostate Cancer Index Composite (EPIC) Sexual Domain

Sexual health domain score of the EPIC survey measuring health-related quality of life with higher scores representing better sexual function on a scale of 0 to 100.

Time frame: At 6 months post-surgery

Patient Score on the Expanded Prostate Cancer Index Composite (EPIC) Sexual Domain

Sexual health domain score of the EPIC survey measuring health-related quality of life with higher scores representing better sexual function on a scale of 0 to 100.

Time frame: At 9 months post-surgery

Patient Score on the Expanded Prostate Cancer Index Composite (EPIC) Sexual Domain

Sexual health domain score of the EPIC survey measuring health-related quality of life with higher scores representing better sexual function on a scale of 0 to 100.

Time frame: At 12 months post-surgery

Patient Score on the Quality of Erection Questionnaire (QEQ)

Survey measuring quality of erections using the QEQ with an overall score range of 0 to 100 where higher scores represent better erection quality.

Time frame: At 3 months post-surgery

Patient Score on the Quality of Erection Questionnaire (QEQ)

Survey measuring quality of erections using the QEQ with an overall score range of 0 to 100 where higher scores represent better erection quality.

Time frame: At 6 months post-surgery

Patient Score on the Quality of Erection Questionnaire (QEQ)

Survey measuring quality of erections using the QEQ with an overall score range of 0 to 100 where higher scores represent better erection quality.

Time frame: At 9 months post-surgery

Patient Score on the Quality of Erection Questionnaire (QEQ)

Survey measuring quality of erections using the QEQ with an overall score range of 0 to 100 where higher scores represent better erection quality.

Time frame: At 12 months post-surgery

Hemoglobin Level at 2 Weeks After Surgery

Hemoglobin level at 2 weeks after surgery in grams per deciliter (g/dl).

Time frame: 2 weeks after surgery

Number of Participants Requiring Transfusion During Hospitalization

Assess the number of participants requiring transfusion during hospitalization.

Time frame: During hospital stay, up to 1 week

Erythropoietin to Enhance Recovery of Erectile Function in Men Following Radical Prostatectomy

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes