Trial of Methoxyflurane With Periprostatic Local Anaesthesia to Reduce the Discomfort of TRUS B (TRUSB)

A Phase 3 Double-blind Placebo-controlled Randomized Trial of Methoxyflurane With Periprostatic Local Anaesthesia to Reduce the Discomfort of Transrectal Ultrasound-guided Prostate Biopsy

A phase 3 double-blind placebo-controlled randomized trial of methoxyflurane with periprostatic local anaesthesia to reduce the discomfort of transrectal ultrasound-guided prostate biopsy (Pain-Free TRUS B).

Study Overview

• Status: Completed
• Conditions: Cancer
• Intervention / Treatment: Drug: Methoxyflurane; Drug: Placebo

Detailed Description

Background Transrectal ultrasound-guided (TRUS) prostate biopsy is associated with significant discomfort, despite the use of periprostatic infiltration of local anaesthetic (PILA).

General aim To determine the efficacy and safety of inhaled methoxyflurane plus PILA versus PILA alone in men undergoing TRUS biopsy of the prostate.

Objectives (endpoints)

To determine the effects of inhaled methoxyflurane on:

Primary

1. Pain-rated by participants 15 minutes after biopsy.

   Secondary

2. Other aspects of the biopsy experience rated by participants 15 minutes and 7-35 days after the biopsy
3. Willingness to undergo a biopsy in the future
4. Urologist's ratings of the participant's biopsy experience (study specific questionnaire completed after the biopsy)
5. Biopsy completion (80% or more of the planned number of biopsies being taken)
6. Frequency of specified adverse events (CTC AE v4.03 and Clavien-Dindo Classification).
7. Frequency of hospitalisation

Design Multi-centre, placebo-controlled, double-blinded, centrally randomised (1:1), stratified, phase 3 trial.

Target population Men scheduled to undergo their first TRUS biopsy of the prostate for a raised PSA or abnormal digital rectal examination (DRE).

Study treatments

Participants randomised to inhaled:

Methoxyflurane (Penthrox®, experimental group). OR Placebo (0.9% saline, control group

All participants are subsequently treated with PILA (2% lignocaine), injected into and around the prostate about 5 minutes before the biopsy.

Assessments Participants will be assessed at time of scheduling of the TRUS prostate biopsy (up to 84 days prior to randomisation), on the day of biopsy, and at the post biopsy clinic (7-35 days after the biopsy). Assessments comprise of medical history and standard blood tests at baseline, patient questionnaire on the day of biopsy and post(7-35 days) biopsy and safety assessments on the day of biopsy and post (7--35 days) biopsy.

Statistical considerations 420 participants provides over 85% power at the two-sided 5% level of significance to detect a 0.80 point difference in mean pain scores (on scale from 0-10) assuming a standard deviation of 2.5 whilst allowing for missing data. A 0.80 point shift in mean pain scores should correspond to a reduction of more than 1/3 in the proportion of men reporting troublesome levels of pain.

• Study Type: Interventional
• Enrollment (Actual): 420
• Phase: Phase 3

Contacts and Locations

Study Locations

• Australia
  • Westmead, Australia
    • Westmead Hospital
  • New South Wales
    • Concord, New South Wales, Australia, 2640
      • Concord Hospital
    • Wahroonga, New South Wales, Australia, 2640
      • Australian Clinical Trials
  • Victoria
    • Berwick, Victoria, Australia
      • Casey Hospital
    • Prahran, Victoria, Australia
      • The Alfred Hospital
  • Western Australia
    • Murdoch, Western Australia, Australia
      • Fiona Stanley Hospital
• New Zealand
  • Christchurch, New Zealand
    • Canterbury Urology Research Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

1. Males older than 18 years scheduled to undergo a TRUS biopsy of the prostate.
2. Adequate liver function: ALT, AST, or bilirubin ≤ 2 x ULN
3. Adequate renal function: serum eGFR> 30 ml/min/1.73m2
4. Willing and able to complete questionnaires in English
5. Willing and able to undergo TRUS biopsy within 7 days of randomisation
6. Willing and able to comply with all study requirements, including treatment, timing and/or nature of required assessments
7. Signed, written informed consent

Exclusion Criteria:

1. Previous TRUS biopsy of the prostate
2. Personal or family history of malignant hyperthermia
3. History of significant liver disease
4. Hypersensitivity to fluorinated anaesthetics or other inhalational anaesthetics
5. Concurrent use of barbiturates or tetracycline antibiotics
6. Concurrent illness that may jeopardise the ability of the patient to undergo the procedures outlined in this protocol with reasonable safety
7. Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule, including alcohol dependence or drug abuse.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Penthrox; Methoxyflurane	Drug: Methoxyflurane; Participants randomised to the experimental arm will inhale methoxyflurane administered through the Penthrox® inhaler starting approximately one minute before insertion of the rectal probe.; Other Names: Penthrox®
PLACEBO_COMPARATOR: Placebo; Saline 0.9%	Drug: Placebo; Participants randomised to the control arm will inhale 0.9% saline administered through the Penthrox® inhaler starting approximately one minute before insertion of the rectal probe.; Other Names: Saline 0.9%

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Pain rated by participants will be self-rated using a numeric rating scale with verbal anchors from 0 (no trouble at all) to 10 (worst I can imagine).	Pain will be assessed at 15 minutes after the TRUS biopsy

Secondary Outcome Measures

Outcome Measure	Time Frame
Other aspects of the biopsy experience rated by participants on the Patient's Experience of TRUS biopsy questionnaire.	Rated at 15 minutes after the biopsy
Other aspects of the biopsy experience rated by participants on the Patient's Experience of TRUS biopsy questionnaire.	Rated at 7-35 days after the biopsy
Willingness to undergo a biopsy in the future assessed by a questionnaire designed specifically for this study.	Rated at 15 minutes and 7-35 days after the biopsy
Urologist's ratings of the participant's biopsy experience, assessed by a questionnaire	On the same day as the TRUS biopsy
Biopsy completion rate.	Recorded on day of TRUS biopsy.
Frequency of specified adverse events.	Adverse events will be recorded after the TRUS biopsy (before the participant leaves the clinic), and 7-35 days after the biopsy.
Frequency of hospitalisation by reviewing hospital records.	Details will be recorded for each emergency department visit and each non-elective hospital admission that occurs within 30 days of the TRUS biopsy.

Collaborators and Investigators

• Sponsor: University of Sydney
• Collaborators: Australian and New Zealand Urogenital and Prostate Cancer Trials Group
• Investigators: Study Chair: Jeremy Grummet, Principal Investigator

Study record dates

Study Major Dates

• Study Start: December 1, 2015
• Primary Completion (ACTUAL): December 5, 2019
• Study Completion (ACTUAL): December 30, 2019

Study Registration Dates

• First Submitted: November 9, 2015
• First Submitted That Met QC Criteria: November 12, 2015
• First Posted (ESTIMATE): November 13, 2015

Study Record Updates

• Last Update Posted (ACTUAL): May 11, 2020
• Last Update Submitted That Met QC Criteria: May 7, 2020
• Last Verified: May 1, 2020

More Information

Terms related to this study

• Keywords: Anaethesiology
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Central Nervous System Depressants; Anesthetics, General; Anesthetics; Anesthetics, Inhalation; Methoxyflurane
• Other Study ID Numbers: ANZUP 1501; ACTRN12615001105538 (REGISTRY: ANZCTR)