Trial of Methoxyflurane With Periprostatic Local Anaesthesia to Reduce the Discomfort of TRUS B

University of Sydney420 enrolled

Overview

A phase 3 double-blind placebo-controlled randomized trial of methoxyflurane with periprostatic local anaesthesia to reduce the discomfort of transrectal ultrasound-guided prostate biopsy (Pain-Free TRUS B).

Background Transrectal ultrasound-guided (TRUS) prostate biopsy is associated with significant discomfort, despite the use of periprostatic infiltration of local anaesthetic (PILA). General aim To determine the efficacy and safety of inhaled methoxyflurane plus PILA versus PILA alone in men undergoing TRUS biopsy of the prostate. Objectives (endpoints) To determine the effects of inhaled methoxyflurane on: Primary 1. Pain-rated by participants 15 minutes after biopsy. Secondary 2. Other aspects of the biopsy experience rated by participants 15 minutes and 7-35 days after the biopsy 3. Willingness to undergo a biopsy in the future 4. Urologist's ratings of the participant's biopsy experience (study specific questionnaire completed after the biopsy) 5. Biopsy completion (80% or more of the planned number of biopsies being taken) 6. Frequency of specified adverse events (CTC AE v4.03 and Clavien-Dindo Classification). 7. Frequency of hospitalisation Design Multi-centre, placebo-controlled, double-blinded, centrally randomised (1:1), stratified, phase 3 trial. Target population Men scheduled to undergo their first TRUS biopsy of the prostate for a raised PSA or abnormal digital rectal examination (DRE). Study treatments Participants randomised to inhaled: Methoxyflurane (Penthrox®, experimental group). OR Placebo (0.9% saline, control group All participants are subsequently treated with PILA (2% lignocaine), injected into and around the prostate about 5 minutes before the biopsy. Assessments Participants will be assessed at time of scheduling of the TRUS prostate biopsy (up to 84 days prior to randomisation), on the day of biopsy, and at the post biopsy clinic (7-35 days after the biopsy). Assessments comprise of medical history and standard blood tests at baseline, patient questionnaire on the day of biopsy and post(7-35 days) biopsy and safety assessments on the day of biopsy and post (7--35 days) biopsy. Statistical considerations 420 participants provides over 85% power at the two-sided 5% level of significance to detect a 0.80 point difference in mean pain scores (on scale from 0-10) assuming a standard deviation of 2.5 whilst allowing for missing data. A 0.80 point shift in mean pain scores should correspond to a reduction of more than 1/3 in the proportion of men reporting troublesome levels of pain.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

420

Conditions

Cancer

Interventions

MethoxyfluraneDRUG

Participants randomised to the experimental arm will inhale methoxyflurane administered through the Penthrox® inhaler starting approximately one minute before insertion of the rectal probe.

PlaceboDRUG

Participants randomised to the control arm will inhale 0.9% saline administered through the Penthrox® inhaler starting approximately one minute before insertion of the rectal probe.

Eligibility

Sex: MALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Males older than 18 years scheduled to undergo a TRUS biopsy of the prostate. 2. Adequate liver function: ALT, AST, or bilirubin ≤ 2 x ULN 3. Adequate renal function: serum eGFR\> 30 ml/min/1.73m2 4. Willing and able to complete questionnaires in English 5. Willing and able to undergo TRUS biopsy within 7 days of randomisation 6. Willing and able to comply with all study requirements, including treatment, timing and/or nature of required assessments 7. Signed, written informed consent Exclusion Criteria: 1. Previous TRUS biopsy of the prostate 2. Personal or family history of malignant hyperthermia 3. History of significant liver disease 4. Hypersensitivity to fluorinated anaesthetics or other inhalational anaesthetics 5. Concurrent use of barbiturates or tetracycline antibiotics 6. Concurrent illness that may jeopardise the ability of the patient to undergo the procedures outlined in this protocol with reasonable safety 7. Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule, including alcohol dependence or drug abuse.

Locations (7)

Concord Hospital

Concord, New South Wales, Australia

Australian Clinical Trials

Wahroonga, New South Wales, Australia

Casey Hospital

Berwick, Victoria, Australia

The Alfred Hospital

Prahran, Victoria, Australia

Outcomes

Primary Outcomes

Pain rated by participants will be self-rated using a numeric rating scale with verbal anchors from 0 (no trouble at all) to 10 (worst I can imagine).

Time frame: Pain will be assessed at 15 minutes after the TRUS biopsy

Secondary Outcomes

Other aspects of the biopsy experience rated by participants on the Patient's Experience of TRUS biopsy questionnaire.

Time frame: Rated at 15 minutes after the biopsy

Other aspects of the biopsy experience rated by participants on the Patient's Experience of TRUS biopsy questionnaire.

Time frame: Rated at 7-35 days after the biopsy

Willingness to undergo a biopsy in the future assessed by a questionnaire designed specifically for this study.

Time frame: Rated at 15 minutes and 7-35 days after the biopsy

Urologist's ratings of the participant's biopsy experience, assessed by a questionnaire

Time frame: On the same day as the TRUS biopsy

Biopsy completion rate.

Time frame: Recorded on day of TRUS biopsy.

Frequency of specified adverse events.

Time frame: Adverse events will be recorded after the TRUS biopsy (before the participant leaves the clinic), and 7-35 days after the biopsy.

Frequency of hospitalisation by reviewing hospital records.

Time frame: Details will be recorded for each emergency department visit and each non-elective hospital admission that occurs within 30 days of the TRUS biopsy.

Data from ClinicalTrials.gov

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