Prostate CancerPhase 3NCT00931528
Tadalafil in Preventing Erectile Dysfunction in Patients With Prostate Cancer Treated With Radiation Therapy
A Phase 3 study testing Tadalafil in people with Prostate Cancer and Sexual Dysfunction, run by Radiation Therapy Oncology Group at 192 sites in 2 countries.
Trial summary
RATIONALE: Tadalafil may help prevent erectile dysfunction (ED) in patients with prostate cancer that has been treated with radiation therapy. It is not yet known whether tadalafil is more effective than a placebo in preventing erectile dysfunction. Read more about this study
- Who is it for?
- Ages 18 to 120 years, men onlyHealthy volunteers can take part
- Conditions the study is for
- Prostate Cancer, Sexual Dysfunction
- What is being tested?
- Tadalafil
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 242 participants
- Where
- 192 sitesin 2 countries
- Study dates
- Nov 2009to Nov 2014
- Phase
- Phase 3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 120 years
- Men only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Clinical stage T1b-T2b (AJCC, 6th ed.) adenocarcinoma of the prostate within 6 months of registration
- Clinically negative lymph nodes as established by imaging (pelvic ± abdominal CT or MR), nodal sampling, or dissection within 3 months prior to registration. Patients with lymph nodes equivocal or questionable by imaging are eligible if the nodes are ≤ 1.5 cm. Lymph node assessment is optional, and at investigator discretion, for patients with Gleason Score <7.
- No evidence of bone metastases (M0) on bone scan within 3 months prior to registration. Equivocal bone scan findings are allowed if plain films are negative for metastasis. Bone metastases assessment is optional, and at investigator discretion, for patients with Gleason Score <7.
- Baseline serum prostatic specific antigen (PSA) value performed with an FDA-approved assay (e.g., Abbott, Hybritech) within 3 months prior to registration.
- -4.1 Any of the following combinations of factors (NOTE: tumor found in 1 or both lobes on biopsy, but not palpable, will not alter T stage):
- T1b-T2b disease, Gleason Score <7 and serum total PSA that is <20 ng/ml or
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- T1b-T2b disease, Gleason Score ≥7 and PSA that is <15 ng/ml
- Serum total testosterone level prior to the initiation of radiation therapy (RT) within normal range according to institutional guidelines
- Zubrod Performance Status 0 or 1 (Appendix III)
- Age ≥ 18 years
- Treatment that will consist of either external beam RT alone to the prostate ± seminal vesicles only at a dose between 75 Gy and 79.2 Gy or brachytherapy alone (NOTE: treatment with combined external RT and brachytherapy excludes patient participation)
- Pretreatment (before starting prostate cancer treatment) erectile function as measured by IIEF Question 1, "How often were you able to get an erection during sexual activity?" - with responses of:
- "sometimes (about half the time)" [response 3] or
- "most times (much more than half the time)" [response 4] or
- "almost always/always" [response 5]
- History of prior tadalafil use: Document usual dosage per sexual encounter, date of last dose, and patient's response (No; Yes-Unsatisfactory Response; Yes-Satisfactory Response). Regardless of past experience, the patient is eligible if he agrees to adhere to protocol and take only tadalafil or placebo prescribed on study.
- Although patients with partners are targeted for recruitment, patients without partners or without partners willing to participate are eligible. Patients (and spouses/partners, if willing to participate) must be able to provide study-specific informed consent.
Who cannot join
- The patient's participation in another medical research study that involves the treatment of ED
- Previous or concomitant invasive cancer (American Joint Committee on Cancer [AJCC] Stage >0), other than localized basal cell or squamous cell skin carcinoma (AJCC Stage 0-II), or a hematological malignancy (e.g., leukemia, lymphoma, myeloma) unless continually disease free for at least 5 years
- History of myocardial infarction within the last year
- Heart failure in the last 6 months
- Uncontrolled arrhythmias, hypotension (<90/50mm Hg), or uncontrolled hypertension (>170/100 mm Hg)
- Stroke within the last 6 months
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- Use of luteinizing hormone-releasing hormone (LHRH) agonist androgen suppression (e.g., Lupron, Zoladex), anti-androgen (e.g., Casodex, Eulexin, Nilandron), or estrogenic (e.g., diethylstilbestrol) agents within the last 6 months
- Current use of any organic nitrate or as needed nitrates (e.g., use of nitroglycerin)
- Current use of cimetidine, ketoconazole, itraconazole, erythromycin, or ritonavir
- Known moderate to severe renal insufficiency or end-stage renal disease
- Known severe hepatic impairment
- Use of mechanical (vacuum) devices, intracorporeal, intraurethral, topical, or oral (sildenafil, tadalafil, vardenafil) agents as therapy for ED or supplements to enhance sexual function within 5-7 days prior to the start of RT. Patients who discontinue these therapies remain eligible if they can meet eligibility criteria
- Pretreatment (before starting prostate cancer treatment) ED as measured by IIEF Question 1, "How often were you able to get an erection during sexual activity?" - with responses of:
- "no sexual activity" [response 0] or
- "almost never/never" [response 1] or
- "a few times (much less than half the time)" [response 2]
- Prior penile implant or history of bilateral orchiectomy
- Prior prostatectomy, prostatic cryosurgery or high-intensity focused ultrasound (HIFU), radionuclide prostate brachytherapy, or chemotherapy for prostate cancer
- Prior or anticipated combined external RT and brachytherapy
- Prior or anticipated external RT to the pelvic ± para-aortic lymph nodes
- Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive. Protocol-specific requirements may also exclude immunocompromised patients.
- Anatomical genital abnormalities or concurrent conditions that in the estimation of the physician would prohibit sexual intercourse or prevent study completion
- Major medical or psychiatric illness which, in the opinion of the investigator, would prevent completion of treatment or would interfere with follow-up
Trial locations and contacts
192 sites in 2 countries.
192 sites in 2 countries
United States183 sites
Abington Memorial Hospital
Abington, Pennsylvania, 19001
Summa Akron City Hospital/Cooper Cancer Center
Akron, Ohio, 44304
New York Oncology Hematology PC - Albany
Albany, New York, 12206
University of New Mexico Cancer Center
Albuquerque, New Mexico, 87106
Saint Vincent Anderson Regional Hospital/Cancer Center
Anderson, Indiana, 46016
Appleton Medical Center
Appleton, Wisconsin, 54911
Mission Hospital-Memorial Campus
Asheville, North Carolina, 28801
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn, California, 95603
University of Colorado Cancer Center - Anschutz Cancer Pavilion
Aurora, Colorado, 80045
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
Saint Agnes Hospital
Baltimore, Maryland, 21229
Johns Hopkins University/Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland, 21287
Summa Barberton Hospital
Barberton, Ohio, 44203
Mary Bird Perkins Cancer Center
Baton Rouge, Louisiana, 70809
Bronson Battle Creek
Battle Creek, Michigan, 49017
Southside Hospital
Bay Shore, New York, 11706
Alta Bates Summit Medical Center-Herrick Campus
Berkeley, California, 94704
Lourdes Hospital
Binghamton, New York, 13905
University of Alabama at Birmingham
Birmingham, Alabama, 35294
IU Health Bloomington
Bloomington, Indiana, 47403
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho, 83706
Veteran Affairs New York Harbor Healthcare System-Brooklyn Campus
Brooklyn, New York, 11209
Bryn Mawr Hospital
Bryn Mawr, Pennsylvania, 19010
Roswell Park Cancer Institute
Buffalo, New York, 14263
Cooper Hospital University Medical Center
Camden, New Jersey, 08103
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park, California, 95682
Mercy San Juan Medical Center
Carmichael, California, 95608
University of Virginia
Charlottesville, Virginia, 22908
Advocate Illinois Masonic Medical Center
Chicago, Illinois, 60657
Enloe Medical Center
Chico, California, 95926
University of Cincinnati
Cincinnati, Ohio, 45267
Siteman Cancer Center - Saint Peters
City of Saint Peters, Missouri, 63376
Clackamas Radiation Oncology Center
Clackamas, Oregon, 97015
Case Western Reserve University
Cleveland, Ohio, 44106
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland, Ohio, 44111
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, 80907
Central Maryland Radiation Oncology in Howard County
Columbia, Maryland, 21044
John B Amos Cancer Center
Columbus, Georgia, 31904
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
Columbus, Ohio, 43210
Ohio State University Medical Center
Columbus, Ohio, 43210
Huron Valley-Sinai Hospital
Commerce, Michigan, 48382
Concord Hospital
Concord, New Hampshire, 03301
Danville Regional Medical Center
Danville, Virginia, 24541
Atlanta VA Medical Center
Decatur, Georgia, 30033
Broward Health North
Deerfield Beach, Florida, 33064
Texas Oncology-Denton South
Denton, Texas, 76210
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, 48201
Henry Ford Hospital
Detroit, Michigan, 48202
Saint John Hospital and Medical Center
Detroit, Michigan, 48236
Wentworth-Douglass Hospital
Dover, New Hampshire, 03820
Delaware County Memorial Hospital
Drexel Hill, Pennsylvania, 19026
Saint Luke's Hospital of Duluth
Duluth, Minnesota, 55805
Duke University Medical Center
Durham, North Carolina, 27710
Willamette Valley Cancer Center
Eugene, Oregon, 97401
Exeter Hospital
Exeter, New Hampshire, 03833
Saint Anne's Hospital
Fall River, Massachusetts, 02721
McLaren-Flint
Flint, Michigan, 48532
Radiation Oncology Associates PC
Fort Wayne, Indiana, 46804
Parkview Hospital Randallia
Fort Wayne, Indiana, 46805
The Klabzuba Cancer Center
Fort Worth, Texas, 76104
Saint Agnes Medical Center
Fresno, California, 93720
Fox Chase Cancer Center Buckingham
Furlong, Pennsylvania, 18925
University of Florida
Gainesville, Florida, 32610
University of Texas Medical Branch at Galveston
Galveston, Texas, 77555-0565
Adams Cancer Center
Gettysburg, Pennsylvania, 17325
Tate Cancer Center
Glen Burnie, Maryland, 21061
IU Health Goshen Center for Cancer Care
Goshen, Indiana, 46526
Mercy Health Saint Mary's
Grand Rapids, Michigan, 49503
Spectrum Health at Butterworth Campus
Grand Rapids, Michigan, 49503
Three Rivers Community Hospital
Grants Pass, Oregon, 97527
Saint Vincent Hospital
Green Bay, Wisconsin, 54301
Cherry Tree Cancer Center
Hanover, Pennsylvania, 17331
High Point Regional Hospital
High Point, North Carolina, 27261
Queen's Medical Center
Honolulu, Hawaii, 96813
University of Hawaii Cancer Center
Honolulu, Hawaii, 96813
The Cancer Center of Hawaii-Liliha
Honolulu, Hawaii, 96817
Cape Cod Hospital
Hyannis, Massachusetts, 02601
Cleveland Clinic Cancer Center Independence
Independence, Ohio, 44131
Baptist Cancer Institute
Jacksonville, Florida, 32207
Cancer Specialists of North Florida-Southside
Jacksonville, Florida, 32207
University of Florida Health Science Center
Jacksonville, Florida, 32209
Mayo Clinic in Florida
Jacksonville, Florida, 32224-9980
Cancer Specialists of North Florida-Baptist South
Jacksonville, Florida, 32258
Cancer Specialists of North Florida-Beaches
Jacksonville Beach, Florida, 32250
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
Good Samaritan Hospital
Kearney, Nebraska, 68847
Academic Urology Prostate Center
King of Prussia, Pennsylvania, 19406
Gundersen Lutheran
La Crosse, Wisconsin, 54601
Mayo Clinic Health System-Franciscan Healthcare
La Crosse, Wisconsin, 54601
Memorial Medical Center - Las Cruces
Las Cruces, New Mexico, 88011
Central Maine Medical Center
Lewiston, Maine, 04240
Baptist Health Lexington
Lexington, Kentucky, 40503
Saint Elizabeth Regional Medical Center
Lincoln, Nebraska, 68510
Veterans Administration Long Beach Medical Center
Long Beach, California, 90822
Elliot Hospital
Manchester, New Hampshire, 03103
Bay Area Medical Center
Marinette, Wisconsin, 54143
Toledo Clinic Cancer Centers-Maumee
Maumee, Ohio, 43537
Hillcrest Hospital Cancer Center
Mayfield Heights, Ohio, 44124
Providence Medford Medical Center
Medford, Oregon, 97504
Rogue Valley Medical Center
Medford, Oregon, 97504
Lake University Ireland Cancer Center
Mentor, Ohio, 44060
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
Southwest General Health Center Ireland Cancer Center
Middleburg Heights, Ohio, 44130
Aurora Saint Luke's Medical Center
Milwaukee, Wisconsin, 53215
Clement J. Zablocki VA Medical Center
Milwaukee, Wisconsin, 53295
Providence Hospital
Mobile, Alabama, 36608
The Coleman Radiation Center-Carteret General Hospital
Morehead City, North Carolina, 28557
Intermountain Medical Center
Murray, Utah, 84157
CarolinaEast Health System-Medical Center
New Bern, North Carolina, 28560
The Hospital of Central Connecticut
New Britain, Connecticut, 06050
Long Island Jewish Medical Center
New Hyde Park, New York, 11040
Ochsner Clinic CCOP
New Orleans, Louisiana, 70121
Columbia University Medical Center
New York, New York, 10032
Christiana Care Health System-Christiana Hospital
Newark, Delaware, 19718
Northridge Hospital Medical Center
Northridge, California, 91325
Kaiser Permanente Oakland-Broadway
Oakland, California, 94611
Oconomowoc Memorial Hospital-ProHealth Care Inc
Oconomowoc, Wisconsin, 53066-3896
West Texas Cancer Center
Odessa, Texas, 79761
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Nebraska Methodist Hospital
Omaha, Nebraska, 68114
UHHS-Chagrin Highlands Medical Center
Orange, Ohio, 44122
21st Century Oncology-Orange Park
Orange Park, Florida, 32073
21st Century Oncology-Palatka
Palatka, Florida, 32177
Advocate Lutheran General Hospital.
Park Ridge, Illinois, 60068
Arizona Center for Cancer Care-Peoria
Peoria, Arizona, 85381
Fox Chase Cancer Center
Philadelphia, Pennsylvania, 19111
Albert Einstein Medical Center
Philadelphia, Pennsylvania, 19141
Providence Portland Medical Center
Portland, Oregon, 97213
Western Oncology Research Consortium
Portland, Oregon, 97213
Providence Saint Vincent Medical Center
Portland, Oregon, 97225
Utah Valley Regional Medical Center
Provo, Utah, 84604-3337
Rapid City Regional Hospital
Rapid City, South Dakota, 57701
Mayo Clinic
Rochester, Minnesota, 55905
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California, 95661
William Beaumont Hospital-Royal Oak
Royal Oak, Michigan, 48073
Radiological Associates of Sacramento
Sacramento, California, 95815
Mercy General Hospital Radiation Oncology Center
Sacramento, California, 95819
Saint Mary's of Michigan
Saginaw, Michigan, 48601
Cancer Specialists of North Florida-Saint Augustine
Saint Augustine, Florida, 32086
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota, 56303
United Hospital
Saint Paul, Minnesota, 55102
Cancer Care Center, Incorporated
Salem, Ohio, 44460
Utah Cancer Specialists-Salt Lake City
Salt Lake City, Utah, 84106
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, 84112
University of Texas Health Science Center
San Antonio, Texas, 78229
UCSF-Mount Zion
San Francisco, California, 94115
California Pacific Medical Center
San Francisco, California, 94118
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia, 31405
Maine Medical Center- Scarborough Campus
Scarborough, Maine, 04074
Mayo Clinic in Arizona
Scottsdale, Arizona, 85259
Arizona Oncology Services Foundation
Scottsdale, Arizona, 85260
Virginia Mason CCOP
Seattle, Washington, 98101
Texas Cancer Center-Sherman
Sherman, Texas, 75090
Memorial Hospital of South Bend
South Bend, Indiana, 46601
Northern Indiana Cancer Research Consortium
South Bend, Indiana, 46628
Kaiser Permanente Cancer Treatment Center
South San Francisco, California, 94080
Spartanburg Regional Medical Center
Spartanburg, South Carolina, 29303
Saint John's Hospital
Springfield, Illinois, 62702
Washington University School of Medicine
St Louis, Missouri, 63110
Barnes-Jewish West County Hospital
St Louis, Missouri, 63141
Dixie Medical Center Regional Cancer Center
St. George, Utah, 84770
Door County Cancer Center
Sturgeon Bay, Wisconsin, 54235-1495
Texas Oncology Cancer Center Sugar Land
Sugar Land, Texas, 77479
South Atlantic Radiation Oncology
Supply, North Carolina, 28462
Flower Hospital
Sylvania, Ohio, 43560
Arizona Oncology Associates-West Orange Grove
Tucson, Arizona, 85704
Tyler Cancer Center
Tyler, Texas, 75702
Carle Cancer Center
Urbana, Illinois, 61801
Sutter Cancer Centers Radiation Oncology Services-Vacaville
Vacaville, California, 95687
Sutter Solano Medical Center
Vallejo, California, 94589
Compass Oncology Vancouver
Vancouver, Washington, 98684
MD Anderson Cancer Center at Cooper-Voorhees
Voorhees Township, New Jersey, 08043
Washington Hospital Center
Washington D.C., District of Columbia, 20010
Waukesha Memorial Hospital - ProHealth Care
Waukesha, Wisconsin, 53188
Aurora West Allis Medical Center
West Allis, Wisconsin, 53227
UHHS-Westlake Medical Center
Westlake, Ohio, 44145
Coastal Carolina Radiation Oncology
Wilmington, North Carolina, 28401
New Hanover Regional Medical Center
Wilmington, North Carolina, 28401
Cancer Treatment Center
Wooster, Ohio, 44691
Cleveland Clinic Wooster Specialty Center
Wooster, Ohio, 44691
Lankenau Medical Center
Wynnewood, Pennsylvania, 19096
WellSpan Health-York Hospital
York, Pennsylvania, 17405
Canada9 sites
Tom Baker Cancer Centre
Calgary, Alberta, T2N 4N2
Cross Cancer Institute
Edmonton, Alberta, T6G 1Z2
Juravinski Cancer Centre at Hamilton Health Sciences
Hamilton, Ontario, L8V 5C2
BCCA-Cancer Centre for the Southern Interior
Kelowna, British Columbia, V1Y 5L3
London Regional Cancer Program
London, Ontario, N6A 4L6
CHUQ - Pavilion Hotel-Dieu de Quebec
Québec, Quebec, G1R 2J6
Allan Blair Cancer Centre
Regina, Saskatchewan, S4T 7T1
BCCA-Fraser Valley Cancer Centre
Surrey, British Columbia, V3V 1Z2
BCCA-Vancouver Cancer Centre
Vancouver, British Columbia, V5Z 4E6
About this study
Official title: A Randomized, Double-blind, Placebo-controlled Phase III Trial to Evaluate the Effectiveness of a Phosphodiesterase 5 Inhibitor, Tadalafil, in Prevention of Erectile Dysfunction in Patients Treated With Radiotherapy for Prostate Cancer
RATIONALE: Tadalafil may help prevent erectile dysfunction (ED) in patients with prostate cancer that has been treated with radiation therapy. It is not yet known whether tadalafil is more effective than a placebo in preventing erectile dysfunction.
PURPOSE: This randomized phase III trial is studying tadalafil to see how well it works compared with a placebo in preventing erectile dysfunction in patients with prostate cancer treated with radiation therapy.
Read the detailed description
OBJECTIVES:
Primary
- To determine whether tadalafil maintains spontaneous (off-drug) erectile function, as measured by the International Index of Erectile Function (IIEF) as compared to placebo at weeks 28-30 after initiation of radiotherapy in patients with prostate cancer.
Secondary
- Determine the difference in spontaneous (off-drug) erectile function between tadalafil and placebo at 1 and 2 years.
- Determine the difference in overall sexual function as measured by the IIEF between tadalafil and placebo at weeks 28-30 and at 1 and 2 years.
- Determine differences in patient and partner overall sexual satisfaction as measured by the Sexual Adjustment Questionnaire (SAQ) between tadalafil and placebo at weeks 28-30 and at 1 and 2 years.
- Determine differences in patient and partner marital adjustment as measured by Locke's Marital Adjustment Test (LMAT) between tadalafil and placebo at weeks 28-30 and at 1 and 2 years.
- Determine associations between patient and partner overall sexual satisfaction as measured by SAQ and patient and partner marital adjustment as measured by LMAT at weeks 28-30 and at 1 and 2 years.
- Determine patient-related factors (i.e., age, pretreatment sexual response, tobacco use, and comorbidities) that may predict response to tadalafil therapy at weeks 28-30 and at 1 and 2 years.
- Determine the difference in adverse events between tadalafil and placebo as assessed by Common Toxicity Criteria for Adverse Effects (CTCAE) v3.0 criteria.
Tertiary
- Characterization of preference and erectile function among patients who choose to stay on (or if on placebo, to start) tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor other than tadalafil, a non-PDE5-inhibitor erectile aide, or no PDE5 inhibitor or erectile aide at 28-30 weeks and at 1 and 2 years.
- Identification of radiotherapy factors (i.e., modality, prescribed total dose, planning target volume margin, penile bulb dose-volume parameters) associated with erectile function.
- Evaluation of the number of patients screened for eligibility, the number eligible that are presented the study, the number who refuse, and the number who are accrued.
OUTLINE: This is a multicenter study. Patients are stratified according to age (≤ 65 years vs > 65 years) and radiotherapy treatment (external beam radiation therapy vs brachytherapy*). Patients are randomized to 1 of 2 treatment arms.
Note: * Radiotherapy start date for brachytherapy patients is the date of the procedure.
All patients undergo either external beam radiotherapy alone to the prostate ± seminal vesicles only or low-dose rate permanent brachytherapy alone.
- Arm I: Beginning ≤ 7 days after the start of radiotherapy, patients receive oral tadalafil once daily for 24 weeks in the absence of disease progression or unacceptable toxicity.
- Arm II: Beginning ≤ 7 days after the start of radiotherapy, patients receive oral placebo once daily for 24 weeks in the absence of disease progression or unacceptable toxicity.
Patients complete the International Index of Erectile Function (IIEF), the Sexual Adjustment Questionnaire (SAQ), the Locke's Marital Adjustment Test (LMAT) (if applicable), and the Expanded Prostate Cancer Index Composite Sexual Medications and Devices Evaluations Supplement questionnaires periodically. Partners or spouses complete the SAQ-Partner, LMAT (if applicable), and IIEF questionnaires periodically.
After completion of study treatment, patients are followed at 28-30 weeks, and annually for up to 2 years.
- Conditions
- Prostate Cancer, Sexual Dysfunction
- Being tested
- Tadalafil, Placebo
- Keywords
- sexual dysfunction, stage IIB prostate cancer, stage IIA prostate cancer, adenocarcinoma of the prostate
- Medical subject headings
- Prostatic Neoplasms, Sexual Dysfunction, Physiological
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TadalafilDrug
Beginning ≤ 7 days after the start of radiotherapy, patients receive oral tadalafil 5mg once daily for 24 weeks.
PlaceboOther
Beginning ≤ 7 days after the start of radiotherapy, patients receive oral placebo once daily for 24 weeks.
| Study group | Role | What they receive |
|---|---|---|
| Tadalafil | Experimental | Tadalafil Receives: Drug: Tadalafil |
| Placebo | Placebo comparator | Placebo Receives: Other: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Percentage of Patients Maintaining Spontaneous (Off-drug) Erectile Function (EF) at Weeks 28-30 After Initiation of Radiation Therapy (RT)
EF is measured by Question 1 of the International Index of Erectile Function (IIEF). The IIEF is a validated 15-item for measuring patient-reported erectile function. Question 1 asks "How often were you able to get an erection during sexual activity?" Responses ranged from 0=no sexual activity, to 5=Almost always or always. Higher scores indicated better functioning. All patients have erectile function prior to initiation of RT, indicated by a score of 3, 4, or 5 on IIEF Q1. Patients with a lower IIEF Q1 score at weeks 28-30 than at baseline will have less erectile function and be categorized as nonresponders. Patients with similar or improved erectile function will be categorized as responders (maintaining). Patient-related predictors of at erectile function at this time point are also reported with this outcome measure.
Measured: Baseline and 30 weeks from the start of radiation therapy
Secondary outcomes (6)
Percentage of Patients Maintaining Spontaneous (Off-drug) EF at Years 1 and 2 After Initiation of RT
The International Index of Erectile Function (IIEF) is a validated 15-item for measuring patient-reported erectile function. Question 1 asks "How often were you able to get an erection during sexual activity?" Responses ranged from 0=no sexual activity, to 5=Almost always or always. Higher scores indicated better functioning. All patients have erectile function prior to initiation of RT, indicated by a score of 3, 4, or 5. Patients with a lower IIEF Q1 score at weeks 28-30 than at baseline will have less erectile function and be categorized as nonresponders. Patients with similar or improved erectile function will be categorized as responders (maintaining). Patient-related predictors of at erectile function at Years 1 and 2 are also reported with this outcome measure.
Measured: Baseline, 1 and 2 years from the start of tadalafil or placebo
Overall Sexual Function as Measured by Change From Baseline in the International Index of Erectile Function (IIEF)
The IIEF is a validated 15-item for measuring patient-reported erectile function. A score of 0-5 is given to each of the 15 questions that examine 5 main domains of male sexual function: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Domain scores are the sum of each item. The erectile function domain has 5 items with a score range of 1-30, orgasmic function has 2 items with a score range of 0-10, sexual desire has 2 items with a score range of 0-10, intercourse satisfaction has 3 items with a score range of 0-15, and overall satisfaction has 2 items with a score range of 2-10. Total score ranges from 0-70, with higher scores indicated better functioning. Change from baseline is calculated by subtracting baseline score from score at the time point of interest.
Measured: Baseline, week 30, and years 1 and 2 from start of treatment
Overall Patient Sexual Satisfaction as Measured by Change From Baseline in the Sexual Adjustment Questionnaire (SAQ) Score
The Sexual Adjustment Questionnaire (SAQ) is a 20-item questionnaire with an overall score range between 8 and 100 including the following domains: desire, ranging between 5 and 30; dysfunction, 0 and 25; activity, 0 and 10; satisfaction, 1 and 10; and fatigue, 1 and 5. The change in SAQ score is calculated by subtracting the baseline score from the follow-up score. A positive change indicates an improvement in sexual well-being.
Measured: Baseline, week 30 and years 1 and 2 after the start of treatment
Overall Partner Sexual Satisfaction as Measured by Change From Baseline in the Sexual Adjustment Questionnaire-Partner (SAQ-P) Score
The SAQ-P is an 18-item questionnaire with an overall score range between 0 and 90 including the following domains: desire, dysfunction, activity, satisfaction, and fatigue. The change in SAQ score is calculated by subtracting the baseline score from the follow-up score. A positive change indicates an improvement in sexual well-being.
Measured: Baseline, week 30 and years 1 and 2 after the start of treatment
Patient Marital Adjustment as Measured by the Locke's Marital Adjustment Test
The Locke Marital Adjustment Test (LMAT) is a 16-item questionnaire with scores ranging from 48 to 138 for participants. Higher scores indicate greater sexual function, sexual wellbeing, or marital adjustment. The change in LMAT score is calculated by subtracting the baseline score from the follow-up score.
Measured: Baseline, week 30 and years 1 and 2 after the start of treatment
Partner Marital Adjustment as Measured by the Locke's Marital Adjustment Test
The Locke Marital Adjustment Test (LMAT) is a 16-item questionnaire with scores ranging from 48 to 138 for participants. Higher scores indicate greater sexual function, sexual wellbeing, or marital adjustment. The change in LMAT score is calculated by subtracting the baseline score from the follow-up score.
Measured: Baseline, week 30 and years 1 and 2 after the start of treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Jul 2009 (estimated)
- Study startNov 2009
- Primary completionDec 2012
- Study completionNov 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Prostate CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 242 participants (actual)
Sponsor and investigators
- Lead sponsor
- Radiation Therapy Oncology Group
- Sponsor type
- Research network
- Collaborators
- National Cancer Institute (NCI), NRG Oncology
- Responsible party
- Sponsor
- Investigators
- Deborah Watkins Bruner, RN, PhD, Principal investigator, Abramson Cancer Center at Penn Medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00931528
- Sponsor's protocol ID
- RTOG 0831
- Other IDs
- CDR0000647146, NCI-2011-01934
- Status last verified
- Jan 2018
- First submitted
- 30 Jun 2009
- Last updated
- 14 Feb 2018
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Publications
Pisansky TM, Pugh SL, Greenberg RE, Pervez N, Reed DR, Rosenthal SA, Mowat RB, Raben A, Buyyounouski MK, Kachnic LA, Bruner DW. Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial. JAMA. 2014 Apr 2;311(13):1300-7. doi: 10.1001/jama.2014.2626.
PubMed 24691606
Study at a glance
From the registry record, last updated by the sponsor on 14 Feb 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-blind, Placebo-controlled Phase III Trial to Evaluate the Effectiveness of a Phosphodiesterase 5 Inhibitor, Tadalafil, in Prevention of Erectile Dysfunction in Patients Treated With Radiotherapy for Prostate Cancer
- ClinicalTrials.gov ID
- NCT00931528
- Acronym / sponsor ID
- RTOG 0831
- Conditions
- Prostate Cancer, Sexual Dysfunction
- Keywords
- sexual dysfunction, stage IIB prostate cancer, stage IIA prostate cancer, adenocarcinoma of the prostate
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 242 participants (actual)
- Lead sponsor
- Radiation Therapy Oncology GroupResearch network
- Collaborators
- National Cancer Institute (NCI), NRG Oncology
- Study start
- Nov 2009
- Primary completion
- Dec 2012 (actual)
- Study completion
- Nov 2014 (actual)
- First posted
- 2 Jul 2009 (estimated)
- Results
- Posted 27 Jul 2016
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
RATIONALE: Tadalafil may help prevent erectile dysfunction (ED) in patients with prostate cancer that has been treated with radiation therapy. It is not yet known whether tadalafil is more effective than a placebo in preventing erectile dysfunction.
PURPOSE: This randomized phase III trial is studying tadalafil to see how well it works compared with a placebo in preventing erectile dysfunction in patients with prostate cancer treated with radiation therapy.
Detailed description
OBJECTIVES:
Primary
- To determine whether tadalafil maintains spontaneous (off-drug) erectile function, as measured by the International Index of Erectile Function (IIEF) as compared to placebo at weeks 28-30 after initiation of radiotherapy in patients with prostate cancer.
Secondary
- Determine the difference in spontaneous (off-drug) erectile function between tadalafil and placebo at 1 and 2 years.
- Determine the difference in overall sexual function as measured by the IIEF between tadalafil and placebo at weeks 28-30 and at 1 and 2 years.
- Determine differences in patient and partner overall sexual satisfaction as measured by the Sexual Adjustment Questionnaire (SAQ) between tadalafil and placebo at weeks 28-30 and at 1 and 2 years.
- Determine differences in patient and partner marital adjustment as measured by Locke's Marital Adjustment Test (LMAT) between tadalafil and placebo at weeks 28-30 and at 1 and 2 years.
- Determine associations between patient and partner overall sexual satisfaction as measured by SAQ and patient and partner marital adjustment as measured by LMAT at weeks 28-30 and at 1 and 2 years.
- Determine patient-related factors (i.e., age, pretreatment sexual response, tobacco use, and comorbidities) that may predict response to tadalafil therapy at weeks 28-30 and at 1 and 2 years.
- Determine the difference in adverse events between tadalafil and placebo as assessed by Common Toxicity Criteria for Adverse Effects (CTCAE) v3.0 criteria.
Tertiary
- Characterization of preference and erectile function among patients who choose to stay on (or if on placebo, to start) tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor other than tadalafil, a non-PDE5-inhibitor erectile aide, or no PDE5 inhibitor or erectile aide at 28-30 weeks and at 1 and 2 years.
- Identification of radiotherapy factors (i.e., modality, prescribed total dose, planning target volume margin, penile bulb dose-volume parameters) associated with erectile function.
- Evaluation of the number of patients screened for eligibility, the number eligible that are presented the study, the number who refuse, and the number who are accrued.
OUTLINE: This is a multicenter study. Patients are stratified according to age (≤ 65 years vs > 65 years) and radiotherapy treatment (external beam radiation therapy vs brachytherapy*). Patients are randomized to 1 of 2 treatment arms.
Note: * Radiotherapy start date for brachytherapy patients is the date of the procedure.
All patients undergo either external beam radiotherapy alone to the prostate ± seminal vesicles only or low-dose rate permanent brachytherapy alone.
- Arm I: Beginning ≤ 7 days after the start of radiotherapy, patients receive oral tadalafil once daily for 24 weeks in the absence of disease progression or unacceptable toxicity.
- Arm II: Beginning ≤ 7 days after the start of radiotherapy, patients receive oral placebo once daily for 24 weeks in the absence of disease progression or unacceptable toxicity.
Patients complete the International Index of Erectile Function (IIEF), the Sexual Adjustment Questionnaire (SAQ), the Locke's Marital Adjustment Test (LMAT) (if applicable), and the Expanded Prostate Cancer Index Composite Sexual Medications and Devices Evaluations Supplement questionnaires periodically. Partners or spouses complete the SAQ-Partner, LMAT (if applicable), and IIEF questionnaires periodically.
After completion of study treatment, patients are followed at 28-30 weeks, and annually for up to 2 years.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Tadalafil | Experimental | Drug: TadalafilTadalafil |
| Placebo | Placebo comparator | Other: PlaceboPlacebo |
Who may qualify
- Ages
- 18 to 120 years
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (17 listed)
- Clinical stage T1b-T2b (AJCC, 6th ed.) adenocarcinoma of the prostate within 6 months of registration
- Clinically negative lymph nodes as established by imaging (pelvic ± abdominal CT or MR), nodal sampling, or dissection within 3 months prior to registration. Patients with lymph nodes equivocal or questionable by imaging are eligible if the nodes are ≤ 1.5 cm. Lymph node assessment is optional, and at investigator discretion, for patients with Gleason Score <7.
- No evidence of bone metastases (M0) on bone scan within 3 months prior to registration. Equivocal bone scan findings are allowed if plain films are negative for metastasis. Bone metastases assessment is optional, and at investigator discretion, for patients with Gleason Score <7.
- Baseline serum prostatic specific antigen (PSA) value performed with an FDA-approved assay (e.g., Abbott, Hybritech) within 3 months prior to registration.
- -4.1 Any of the following combinations of factors (NOTE: tumor found in 1 or both lobes on biopsy, but not palpable, will not alter T stage):
Key exclusion criteria (23 listed)
- The patient's participation in another medical research study that involves the treatment of ED
- Previous or concomitant invasive cancer (American Joint Committee on Cancer [AJCC] Stage >0), other than localized basal cell or squamous cell skin carcinoma (AJCC Stage 0-II), or a hematological malignancy (e.g., leukemia, lymphoma, myeloma) unless continually disease free for at least 5 years
- History of myocardial infarction within the last year
- Heart failure in the last 6 months
- Uncontrolled arrhythmias, hypotension (<90/50mm Hg), or uncontrolled hypertension (>170/100 mm Hg)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| TadalafilBeginning ≤ 7 days after the start of radiotherapy, patients receive oral tadalafil 5mg once daily for 24 weeks. | Drug | Tadalafil |
| PlaceboBeginning ≤ 7 days after the start of radiotherapy, patients receive oral placebo once daily for 24 weeks. | Other | Placebo |
Primary outcome
Percentage of Patients Maintaining Spontaneous (Off-drug) Erectile Function (EF) at Weeks 28-30 After Initiation of Radiation Therapy (RT)
Time frame: Baseline and 30 weeks from the start of radiation therapy
EF is measured by Question 1 of the International Index of Erectile Function (IIEF). The IIEF is a validated 15-item for measuring patient-reported erectile function. Question 1 asks "How often were you able to get an erection during sexual activity?" Responses ranged from 0=no sexual activity, to 5=Almost always or always. Higher scores indicated better functioning. All patients have erectile function prior to initiation of RT, indicated by a score of 3, 4, or 5 on IIEF Q1. Patients with a lower IIEF Q1 score at weeks 28-30 than at baseline will have less erectile function and be categorized as nonresponders. Patients with similar or improved erectile function will be categorized as responders (maintaining). Patient-related predictors of at erectile function at this time point are also reported with this outcome measure.
6 secondary outcomes
Percentage of Patients Maintaining Spontaneous (Off-drug) EF at Years 1 and 2 After Initiation of RT
Time frame: Baseline, 1 and 2 years from the start of tadalafil or placebo
Overall Sexual Function as Measured by Change From Baseline in the International Index of Erectile Function (IIEF)
Time frame: Baseline, week 30, and years 1 and 2 from start of treatment
Overall Patient Sexual Satisfaction as Measured by Change From Baseline in the Sexual Adjustment Questionnaire (SAQ) Score
Time frame: Baseline, week 30 and years 1 and 2 after the start of treatment
Overall Partner Sexual Satisfaction as Measured by Change From Baseline in the Sexual Adjustment Questionnaire-Partner (SAQ-P) Score
Time frame: Baseline, week 30 and years 1 and 2 after the start of treatment
Patient Marital Adjustment as Measured by the Locke's Marital Adjustment Test
Time frame: Baseline, week 30 and years 1 and 2 after the start of treatment
Partner Marital Adjustment as Measured by the Locke's Marital Adjustment Test
Time frame: Baseline, week 30 and years 1 and 2 after the start of treatment
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Feb 2018.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 24691606Pisansky TM, Pugh SL, Greenberg RE, Pervez N, Reed DR, Rosenthal SA, Mowat RB, Raben A, Buyyounouski MK, Kachnic LA, Bruner DW. Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial. JAMA. 2014 Apr 2;311(13):1300-7. doi: 10.1001/jama.2014.2626.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Deborah Watkins Bruner, RN, PhD principal investigator
Abramson Cancer Center at Penn Medicine
192 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Tadalafil in people with Prostate Cancer and Sexual Dysfunction, run by Radiation Therapy Oncology Group at 192 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 17 inclusion and 23 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 14 Feb 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 192 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 27 Jul 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Percentage of Patients Maintaining Spontaneous (Off-drug) Erectile Function (EF) at Weeks 28-30 After Initiation of Radiation Therapy (RT) (time frame: Baseline and 30 weeks from the start of radiation therapy). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00931528, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Feb 2018.