RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Androgens can stimulate the growth of prostate cancer cells. Hormone therapy can fight prostate cancer by androgen deprivation. It is not yet known if neoadjuvant radiation therapy is a more effective therapy for high-risk prostate cancer. PURPOSE: Two-stage randomized trial to compare the effectiveness and safety of neoadjuvant radiotherapy and hormone therapy followed by radical prostatectomy in men with high-risk locally advanced prostate cancer
PRIMARY OBJECTIVE: I. Success rate of salvage radiation therapy (SRT) measured as pathologic complete response (pCR) or pathologic near complete response (minimal residual disease, MRD) rate. SECONDARY OBJECTIVES: I. PSA decline rate after neoadjuvant treatment, rate of undetectable PSA after RP, rate of positive surgical margin, and rate of pathologic down-staging (≤ ypT2N0) II. Biochemical recurrence-free survival rate (from date of randomization). III. Metastasis free survival. IV. Prostate Cancer Death. V. Overall Survival OUTLINE: Participants are randomized to 1 of 2 arms. ARM I: Participants receive neoadjuvant hormone and radiation therapy, and then radical prostatectomy ARM II: Participants receive neoadjuvant hormone therapy, and then radical prostatectomy. After intervention, participants are followed up periodically for up to 20 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
38
Intensity modulated radiation therapy (IMRT), with 50 Gy in 25 daily fractions (2 Gy/fraction, 5 fractions weekly) for 5 weeks (week 1 - week 5).
Gosereline 3.6mg sc injection at week 1, week 5, and week 9
Eligible patients will undergo robotic-assisted radical prostatectomy and pelvic lymph node dissection
National Taiwan University Hospital Yunlin Branch
Douliu City/Huwei Township, Yunlin County, Taiwan
RECRUITINGNational Taiwan University Hospital
Tapiei, Taiwan
RECRUITINGPathologic outcome
pathologic complete response (pCR) or pathologic near complete response (minimal residual disease, MRD) rate
Time frame: From date of randomization to the date of radical prostatectomy, up to 100 weeks
PSA decline percentage
PSA decline is defined as nadir PSA value/baseline PSA value × 100
Time frame: From date of randomization to 10 years
PSA complete response rate
Complete response is defined as a drop in PSA on protocol treatment to less than 0.2 ng/ml.
Time frame: From date of randomization to 10 years
PSA Recurrence
Biochemical recurrence is defined as a rise in PSA to 0.2 ng/mL and a confirmatory value of 0.2 ng/mL or greater following radical prostatectomy
Time frame: From date of randomization to 10 years
Distant Failure
Distant failure rate is estimated by the cumulative incidence method, with failure defined as the first occurrence of distant failure.
Time frame: From date of randomization to 10 years
Prostate Cancer Death
Prostate cancer death rate us estimated by the cumulative incidence method, with failure defined as death due to prostate cancer or complications of trial.
Time frame: From date of randomization to 10 years
Overall Survival
Overall survival is estimated by the Kaplan-Meier method, with failure defined as death by any cause.
Time frame: From date of randomization to 10 years
Progression-free Survival
Progress-free survival is estimated by the Kaplan-Meier method, with failure defined as the first occurrence of PSA failure, local, regional or distant failure, or death from any cause.
Time frame: From date of randomization to 10 years
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