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Dinneen E, Shaw GL, Kealy R, Alexandris P, Finnegan K, Chu K, Haidar N, Santos‐Vidal S, Kudahetti S, Moore CM, Grey ADR, Berney DM, Sahdev A, Cathcart PJ, Oliver RTD, Rajan P, Cuzick J. Feasibility of aspirin and/or vitamin D3 for men with prostate cancer on active surveillance with Prolaris® testing. BJUI Compass 2022; 3:458-465. [PMID: 36267207 PMCID: PMC9579886 DOI: 10.1002/bco2.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To test the feasibility of a randomised controlled trial (RCT) of aspirin and/or vitamin D3 in active surveillance (AS) low/favourable intermediate risk prostate cancer (PCa) patients with Prolaris® testing. Patients and Methods Newly-diagnosed low/favourable intermediate risk PCa patients (PSA ≤ 15 ng/ml, International Society of Urological Pathology (ISUP) Grade Group ≤2, maximum biopsy core length <10 mm, clinical stage ≤cT2c) were recruited into a multi-centre randomised, double-blind, placebo-controlled study (ISRCTN91422391, NCT03103152). Participants were randomised to oral low dose (100 mg), standard dose (300 mg) aspirin or placebo and/or vitamin D3 (4000 IU) versus placebo in a 3 × 2 factorial RCT design with biopsy tissue Prolaris® testing. The primary endpoint was trial acceptance/entry rates. Secondary endpoints included feasibility of Prolaris® testing, 12-month disease re-assessment (imaging/biochemical/histological), and 12-month treatment adherence/safety. Disease progression was defined as any of the following (i) 50% increase in baseline PSA, (ii) new Prostate Imaging-Reporting and Data System (PI-RADS) 4/5 lesion(s) on multi-parametric MRI where no previous lesion, (iii) 33% volume increase in lesion size, or radiological upstaging to ≥T3, (iv) ISUP Grade Group upgrade or (v) 50% increase in maximum cancer core length. Results Of 130 eligible patients, 104 (80%) accepted recruitment from seven sites over 12 months, of which 94 patients represented the per protocol population receiving treatment. Prolaris® testing was performed on 76/94 (81%) diagnostic biopsies. Twelve-month disease progression rate was 43.3%. Assessable 12-month treatment adherence in non-progressing patients to aspirin and vitamin D across all treatment arms was 91%. Two drug-attributable serious adverse events in 1 patient allocated to aspirin were identified. The study was not designed to determine differences between treatment arms. Conclusion Recruitment of AS PCa patients into a multi-centre multi-arm placebo-controlled RCT of minimally-toxic adjunctive oral drug treatments with molecular biomarker profiling is acceptable and safe. A larger phase III study is needed to determine optimal agents, intervention efficacy, and outcome-associated biomarkers.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Gregory L. Shaw
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Roseann Kealy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Present address:
Cancer Prevention Trial Unit, School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK.
| | - Panos Alexandris
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Kier Finnegan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Kimberley Chu
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Nadia Haidar
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Sara Santos‐Vidal
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Sakunthala Kudahetti
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Caroline M. Moore
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
| | - Alistair D. R. Grey
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Daniel M. Berney
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
- Department of Cellular Pathology, The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Anju Sahdev
- Department of Radiology, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Paul J. Cathcart
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - R. Timothy D. Oliver
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Prabhakar Rajan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of Urology, University College Hospital at Westmoreland StreetUniversity College Hospital London NHS Foundation TrustLondonUK
- Department of Urology, The Royal London HospitalBarts Health NHS TrustLondonUK
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
| | - Jack Cuzick
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Cancer Research UK Barts CentreQueen Mary University of LondonLondonUK
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