This phase II trial studies how well apalutamide, abiraterone acetate, prednisone, degarelix, and indomethacin work in treating patients with prostate cancer that has spread from where it started to nearby tissue or lymph nodes before surgery. Androgen can cause the growth of tumor cells. Hormone therapy using apalutamide, abiraterone acetate, prednisone, degarelix, and indomethacin may fight prostate cancer by lowering the amount of androgen the body makes and/or blocking the use of androgen by the tumor cells.
PRIMARY OBJECTIVES: I. The rate of the pathologic complete response (pCR) (i.e. no evidence of residual tumor) as assessed on prostatectomy specimens following 3-months (12 weeks) of neoadjuvant apalutamide, abiraterone acetate, degarelix and indomethacin. SECONDARY OBJECTIVES: I. To determine the negative margin rate as assessed on prostatectomy specimens following 3-months (12 weeks) of neoadjuvant apalutamide, abiraterone acetate, degarelix and indomethacin. II. To determine the rate of near pCR (i.e. =\< 5 mm of residual tumor) as assessed on prostatectomy specimens following 3-months (12 weeks) of neoadjuvant apalutamide, abiraterone acetate, degarelix and indomethacin. III. To determine the rate of pathologic T3 disease as assessed on prostatectomy specimens following 3-months (12 weeks) of neoadjuvant apalutamide, abiraterone acetate, degarelix and indomethacin. IV. To determine the rate of nodal metastases as assessed on surgical lymph node specimens following 3-months (12 weeks) of neoadjuvant apalutamide, abiraterone acetate, degarelix and indomethacin. V. To determine the apoptotic index (i.e. percentage of tumor cells undergoing apoptosis) as determined by cleaved caspase-3 immunohistochemistry following 3-months (12 weeks) of neoadjuvant apalutamide, abiraterone acetate, degarelix and indomethacin. VI. To determine the proportion of men who receive adjuvant radiation therapy within 1-year of prostatectomy. VII. To determine the biochemical (i.e. prostate-specific antigen \[PSA\]) progression free survival estimate two years after the last patient has accrued (i.e. confirmed PSA post-radical prostatectomy \>= 0.2 ng/mL). VIII. To determine the overall survival estimate two years after the last patient has accrued. IX. Safety as assessed by the incidence and severity of adverse events and serious adverse events graded according to the National Cancer Institute - Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. X. Exploratory biomarker assessment. OUTLINE: Patients receive apalutamide and abiraterone acetate orally (PO) daily, prednisone PO twice per day (BID) and indomethacin PO three times per day (TID). Patients also receive degarelix subcutaneously (SC) on day 1 and every 4 weeks for 3 doses. Treatment continues for up to 12 weeks in the absence of disease progression or unacceptable toxicity. Patients undergo prostatectomy on day 85. After completion of study treatment, patients are followed up at 28, 113, 450 and 815 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Given PO
Given PO
Given SC
Given PO
Correlative study
Given PO
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Pathologic Complete Response Rate as Assessed From Prostatectomy Specimens Following Neoadjuvant Treatment
Pathologic complete response is defined as no evidence of cancer on fully submitted prostatectomy specimens using standard surgical pathology assessments (i.e. H\&E assessment will be used for the purpose of defining pathologic complete response per protocol) at 3 months.
Time frame: At 3 months
Apoptotic Index (i.e. Percentage of Tumor Cells Undergoing Apoptosis)
Will be determined by cleaved caspase-3 immunohistochemistry.
Time frame: At 3 months
Number of Patients With a Negative Margin After 3 Months of Treatment
The absence of tumor cells at the prostate margin will be assessed using standard pathological practices on prostatectomy specimens (i.e. after 3 months of treatment).
Time frame: At 3 months
Overall Survival (OS)
Will will report the number of participants alive at 2-years following enrollment.
Time frame: At 2 years
Number of Patients With a Near Pathologic Complete Response After 3 Months of Treatment
The near pathologic complete response will be defined as =\< 5 mm of residual tumor as assessed on prostatectomy specimens after 3 months of treatment.
Time frame: At 3 months
Number of Patients With no Nodal Metastases After 3 Months of Treatment.
The presence of tumor cells within surgically excised lymph nodes will be assessed after 3 months of treament.
Time frame: At 3 months
Number of Patients With Pathologic T3 Disease After 3 Months of Treatment.
The presence of T3 disease (e.g. extraprostatic tumor not invading adjacent structures) will be determine from the prostatectomy specimen after 3 months of treament.
Time frame: At 3 months
Number of Participants Without Biochemical Failure at 2 Years
Prostate-specific antigen progression (i.e. biochemical failure) will be defined per the American Urological Association guidelines (i.e. confirmed prostate-specific antigen post-radical prostatectomy \>= 0.2 ng/mL). We will report the number of patients without biochemical failure at 2 years.
Time frame: At 2 years
The Proportion of Men Who Receive Adjuvant Radiation Therapy
Patients that received radiation following prostatetomy
Time frame: Up to 1 year post prostatectomy
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