Prostate Cancer - Comparative Outcomes of New Conceptual Paradigms for Treatment

Completed

Conditions: Prostate Cancer

Interventions: Other: Patient-reported questionnaire

Registration Number: NCT04890314

Lead Sponsor: Weill Medical College of Cornell University

Brief Summary: This study will use a population-based cohort design to study men with newly diagnosed low- and intermediate-risk prostate cancer at high-volume centers in Southern California (SCa) and New York State (NYS). Complications of contemporary treatments for prostate cancer and quality of life outcomes, such as general health, urinary, sexual, and bowel function, cancer anxiety, and treatment regret will be compared and tracked over the course of this study.

Detailed Description: Prostate cancer remains the most commonly diagnosed, solid organ tumor and the second most common cause of cancer death in U.S. men. Technological advances have enabled new treatment options, such as stereotactic body radiation therapy (SBRT) and partial gland ablation (PGA). Although heavily marketed as more convenient with fewer side effects, there is an absence of high-level, comparative effective research (CER) to discern relative outcomes to traditional therapies such as active surveillance (AS), radical prostatectomy (RP) and intensity modulated radiation therapy (IMRT).

Investigators hypothesize that PGA will be associated with less reduction of urinary and sexual function compared to before treatment than both RP and IMRT. SBRT is hypothesized to be associated with less reduction of urinary and sexual function before treatment compared to RP and IMRT. SBRT is hypothesized to be associated with less reduction in bowel function compared to IMRT. PGA hypothesized to be associated with better overall quality of life at 12 months compared to AS. Investigators hypothesize PGA and SBRT will be associated with fewer adverse events compared to RP and IMRT.

The investigators will conduct a pragmatic, population-based cohort study of men with newly diagnosed low and intermediate risk prostate cancer in Southern California (SCa) and New York State (NYS) Surveillance Epidemiology and End Results (SEER) regions to bridge the evidence gap concerning adverse events and patient reported outcomes. This study will inform multiple stakeholders, who contributed to the study design. Stakeholders include prostate cancer survivors, payers, medical device manufacturers, professional organizations, community and academic prostate cancer experts and the Food and Drug Administration (FDA).

Recruitment & Eligibility

Status: COMPLETED

Sex: Male

Target Recruitment: 1953

Inclusion Criteria

Pathologically-confirmed clinically localized prostate adenocarcinoma with National Comprehensive Cancer Network (NCCN) low (T1-T2a, Gleason 6, Grade Group 1, PSA <10 ng/mL) or intermediate risk (T2b-T2c or, Gleason 7, Grade Group 2 or 3 or PSA 10-20 ng/mL)72 at one of the selected hospitals in SCa and NYS
Diagnosis date during the 18 month recruitment window
Able to read/speak English or Spanish
Agree to participate by completing the baseline questionnaire

Exclusion Criteria

Clinically metastatic disease or high-risk PCa (T3a-T4, Gleason Grade Group 4 or 5 or PSA >20 ng/mL
Unable to read/speak English or Spanish
Unwilling or unable to give informed consent.

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Active Surveillance (AS)	Patient-reported questionnaire	Doctor will monitor the patient without directly treating the cancer.
Radical Prostatectomy (RP)	Patient-reported questionnaire	Prostate surgery that removes the whole prostate.
Stereotactic Body Radiation Therapy (SBRT)	Patient-reported questionnaire	Radiation treatment of prostate cancer requiring less than 2 weeks of treatment.
Intensity-Modulated Radiation Therapy (IMRT)	Patient-reported questionnaire	Radiation treatment of prostate cancer requiring more than 2 weeks of treatment.
Partial Gland Ablation (PGA)	Patient-reported questionnaire	Prostate cancer treatment that involves only treating part of the prostate that has cancer. Examples include, but are not limited to, high intensity focused ultrasound (HIFU) and cryotherapy.

Primary Outcome Measures

Name	Time	Method
Assessing Percentage of Participants Who Reported Adverse Events Following Treatment by Common Terminology Criteria for Adverse Events (CTCAE) v5.0	12 months	All adverse events will be graded as an event occurred, event will indicate an adverse event occurred. observations only; intervention not indicated.
Change in Patient-Reported Quality of Life as Measured on EQ-5D-5L	8 months, 12 months	Adjusted quality of life scores for active surveillance (AS), radical prostatectomy (RP) and partial gland ablation (PGA) at 8 and 12 months showing the mean reported score on a scale from 0-100 with a higher score indicating better function or better health.
Change in Patient-Reported Urinary Function, Urinary Incontinence, Urinary Irritation, Sexual Function, Bowel Function and Hormonal Function as Measured on Expanded Prostate Cancer Index Composite (EPIC-26)	8 months, 12 months	The Expanded Prostate Cancer Index Composite (EPIC-26) is a 26-item questionnaire, dichotomized by severity, assessing four domains: urinary, sexual, bowel, and hormonal function. Each domain is scored 0-100, with higher scores indicating greater dysfunction.
Change in Ejaculatory Function as Measured on Male Sexual Health Questionnaire - Ejaculatory Function and Related Distress (MSHQ-EjD)	8 months, 12 months	The Male Sexual Health Questionnaire - Ejaculatory Function and Related Distress (MSHQ-EjD) is a 4-item questionnaire measuring severity of ejaculatory dysfunction. The 4 items are degree of bother, ejaculatory force, ejaculatory volume, and frequency of ejaculation, and the total score is measured on a scale of 1-20, with higher scores indicating greater dysfunction. Scores were adjusted for age, race (Black, white or other), number of comorbidities (0, 1, 2, \>= 3) and NCCN risk (low vs intermediate).
Patient-Reported Anxiety Based on Memorial Anxiety Prostate Cancer Questionnaire (MAX-PC)	12 months	The Memorial Anxiety Scores for Prostate Cancer (MAX-PC) is an 18-item questionnaire measuring treatment anxiety. Total scores ranged from 0-54, with higher scores associated with higher anxiety, the mean of patient reported MAX-PC scores by treatment group are shown below.
Assessment of Cancer Recurrence Following Treatment as Measured by Prostate Specific Antigen Levels	12 months	Patient PSA levels (ng/mL) will be obtained through medical record review of laboratory (blood) results. Information below reflects the percentage of subjects that were estimated to have risk of recurrence based on their reported PSA by treatment group.
Assessment of Treatment Regret as Measured on Clark's Prostate Cancer Health Worry	12 months	Clark's Prostate Cancer Health Worry is a 5-item questionnaire measuring treatment regret. All items are scored 0-100, with higher scores indicating greater treatment regret.

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (4): Weill Cornell Medicine
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New York, New York, United States
New York State Department of Health
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Albany, New York, United States
University of Kansas
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Kansas City, Kansas, United States
University of Southern California
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Los Angeles, California, United States