Prostate Cancer Clinical Trial
Radiation Therapy in Treating Patients With Stage II Prostate Cancer
RATIONALE: Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. It is not yet known which dose of radiation therapy is more effective in treating stage II prostate cancer.
PURPOSE: Randomized phase III trial to compare the effectiveness of two different doses of specialized radiation therapy in treating patients who have stage II prostate cancer.
Compare the overall survival of patients with stage II adenocarcinoma of the prostate treated with high- vs standard-dose three-dimensional conformal or intensity-modulated radiotherapy.
Compare the freedom from prostate-specific antigen failure, disease-specific survival, local progression, and distant metastases in patients treated with these regimens.
Compare the probability of tumor control and normal tissue complications in patients treated with these regimens.
Compare the incidence of grade 2 or greater genitourinary and gastrointestinal acute and late toxicity in patients treated with these regimens.
Compare the quality of life, including sexual function, of patients treated with these regimens.
Correlate histopathologic or tumor-specific cytogenetic or chromosomal markers with cancer control outcomes in patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to Gleason score and prostate-specific antigen (PSA) level (Gleason score 2-6, PSA ≥10 mg/mL but < 20 ng/mL vs Gleason score 7, PSA < 15 ng/mL) and radiation modality (three-dimensional conformal radiotherapy [3D-CRT] vs intensity-modulated radiotherapy [IMRT]). Patients are randomized to 1 of 2 treatment arms.
Arm I: Patients undergo standard-dose 3D-CRT or IMRT once daily, 5 days a week, for 7.8 weeks (39 treatment days).
Arm II: Patients undergo high-dose 3D-CRT or IMRT once daily, 5 days a week, for 8.8 weeks (44 treatment days).
Quality of life (QOL) is assessed initially at baseline. After completion of radiotherapy, QOL is assessed every 3 months for 1 year and then every 6 months for 4 years.
Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 1,520 patients (760 per treatment arm) will be accrued for this study within 5 years.
Histologically confirmed adenocarcinoma of the prostate
Clinical stage T1b-T2b
Meets one of the following criteria:
Gleason score 2-6 AND prostate-specific antigen (PSA) ≥ 10 ng/mL but < 20 ng/mL
Gleason score 7 AND PSA < 15 ng/mL
No regional lymph node involvement
No distant metastases
No other invasive malignancy within the past 5 years except localized basal cell or squamous cell skin cancer
No other major medical or psychiatric illness that would preclude study participation
PRIOR CONCURRENT THERAPY:
No prior cytotoxic chemotherapy
No concurrent cytotoxic chemotherapy
At least 3 months since prior finasteride
No other prior hormonal therapy, including:
Luteinizing hormone-releasing hormone agonists (e.g., goserelin or leuprolide)
Antiandrogens (e.g., flutamide or bicalutamide)
Estrogens (e.g., diethylstilbestrol)
No concurrent (neoadjuvant or adjuvant) hormonal therapy
No prior pelvic irradiation or brachytherapy
No prior radical surgery (prostatectomy) or cryosurgery for prostate cancer
No prior surgical castration (bilateral orchiectomy)
At least 3 months since prior finasteride or phytoestrogen preparation (PC-SPES)
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