Neoadjuvant Intraprostatic OnabotulinumtoxinA Before Radical Prostatectomy for High-Risk Localized Prostate Cancer
A Pilot Randomized, Single Blind, Placebo Controlled Study of Neoadjuvant Intraprostatic OnabotulinumtoxinA Prior to Radical Prostatectomy in Patients With High Risk Localized Prostate Cancer
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
High-risk localized prostate cancer is associated with a substantial risk of adverse pathological features and disease recurrence despite definitive treatment with radical prostatectomy. Emerging evidence suggests that neural signaling within the prostate tumor microenvironment contributes to tumor growth, progression, and treatment resistance. OnabotulinumtoxinA (BOTOX®), a neurotoxin that blocks acetylcholine release, has demonstrated biological effects in prostate tissue and may provide a novel approach to modulating tumor-associated neural pathways.
This single-center, prospective, randomized, single-blind, placebo-controlled pilot study will enroll 30 men with high-risk or very-high-risk localized prostate adenocarcinoma who are scheduled to undergo radical prostatectomy. Participants will be randomized in a 1:1 ratio to receive either a single transrectal ultrasound-guided intraprostatic injection of onabotulinumtoxinA (50 units) or an equivalent-volume normal saline placebo 6 to 8 weeks prior to surgery. Participants will remain blinded to treatment assignment.
The primary objective is to evaluate study feasibility and safety, including participant accrual, protocol adherence, successful completion of intraprostatic injection and planned surgery, and the incidence and severity of adverse events. Secondary objectives include evaluation of pathological outcomes at prostatectomy, including Gleason score, perineural invasion, stromogenic component, tumor burden, pathological stage, and surgical margin status. Early postoperative PSA outcomes will also be assessed. Exploratory analyses will evaluate time to biochemical recurrence following radical prostatectomy.
This pilot study is not powered to demonstrate clinical efficacy. Instead, it is designed to establish the safety and feasibility of neoadjuvant intraprostatic onabotulinumtoxinA and generate preliminary biological and pathological data to support future studies investigating neural modulation as a therapeutic strategy in prostate cancer.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
- Fase 1
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Vivian MacDonnell, MD
- Telefonnummer: 7134928703
- E-mail: vmmacdonnell@houstonmethodist.org
Undersøgelse Kontakt Backup
- Navn: Brian Miles, MD
- Telefonnummer: 7138170870
- E-mail: bjmiles@houstonmethodist.org
Studiesteder
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Texas
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Houston, Texas, Forenede Stater, 77030
- Houston Methodist
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-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Male, ≥ 45 years
- Histologically confirmed prostate adenocarcinoma
- Gleason score ≥8 on biopsy
- Candidate for and scheduled to undergo RALP for primary treatment
- ECOG 0-2
- Able to read, speak, and understand English
- Able to provide informed consent
Exclusion Criteria:
- Prior prostate cancer therapy (radiation, ADT, chemotherapy)
- Metastatic disease
- Known hypersensitivity to botulinum toxin
- Neuromuscular disorders (e.g., myasthenia gravis)
- Active infection, coagulopathy, or contraindication to transperineal injection
- Medications significantly affecting neuromuscular transmission (clinically relevant)
- Any condition compromising safety or protocol compliance
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Botox
A single transperineal, transrectal ultrasound (TRUS)-guided intraprostatic injection of onabotulinumtoxinA, total dose 50 units, administered 6 to 8 weeks prior to radical prostatectomy.
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A single transperineal, transrectal ultrasound (TRUS)-guided intraprostatic injection of onabotulinumtoxinA, total dose 50 units, administered 6 to 8 weeks prior to radical prostatectomy.
Andre navne:
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Placebo komparator: Placebo
A single transperineal, transrectal ultrasound (TRUS)-guided intraprostatic injection of normal saline placebo administered in an identical volume and injection pattern 6 to 8 weeks prior to radical prostatectomy.
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Participants randomized to the placebo arm will receive a single transperineal, transrectal ultrasound (TRUS)-guided intraprostatic injection of normal saline administered in an identical volume and injection pattern as the active treatment arm, 6 to 8 weeks prior to planned radical prostatectomy.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Participant Accrural
Tidsramme: Through study completion, an average of 1 year
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Number of participants enrolled in the study
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Through study completion, an average of 1 year
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Protocol Adherence
Tidsramme: Through study completion, an average of 1 year
|
Proportion of participants who complete study procedures according to protocol requirements.
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Through study completion, an average of 1 year
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Successful Completion of Intraprostatic Injection
Tidsramme: At time of surgery
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Number of participants who successfully receive the assigned intraprostatic study injection.
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At time of surgery
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Incidence of Adverse Events
Tidsramme: From study injection through 36 months of follow-up.
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Incidence, severity, seriousness, and relationship of adverse events associated with intraprostatic administration of onabotulinumtoxinA or placebo.
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From study injection through 36 months of follow-up.
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Successful Completion of Planned Radical Prostatectomy
Tidsramme: Within 6 to 8 weeks after intraprostatic injection.
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Proportion of participants who undergo planned radical prostatectomy following study intervention without study-related cancellation or unacceptable delay.
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Within 6 to 8 weeks after intraprostatic injection.
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Gleason Score at Radical Prostatectomy
Tidsramme: At radical prostatectomy (6 to 8 weeks after study injection).
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Comparison of Gleason score determined from radical prostatectomy specimens between treatment arms. Gleason Score determined from radical prostatectomy specimens. Gleason Scores range from 6 to 10, with higher scores indicating more aggressive prostate cancer. |
At radical prostatectomy (6 to 8 weeks after study injection).
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Perineural Invasion
Tidsramme: At radical prostatectomy (6 to 8 weeks after study injection).
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Presence and extent of perineural invasion identified in radical prostatectomy specimens.
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At radical prostatectomy (6 to 8 weeks after study injection).
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Stromogenic Component
Tidsramme: At radical prostatectomy (6 to 8 weeks after study injection).
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Assessment of stromogenic component in radical prostatectomy specimens.
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At radical prostatectomy (6 to 8 weeks after study injection).
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Tumor Size
Tidsramme: At radical prostatectomy (6 to 8 weeks after study injection).
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Tumor size measured in radical prostatectomy specimens.
The measurement will be recorded in centimeters (cm).
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At radical prostatectomy (6 to 8 weeks after study injection).
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Positive Surgical Margin Status
Tidsramme: At radical prostatectomy (6 to 8 weeks after study injection).
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Proportion of participants with positive surgical margins following radical prostatectomy.
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At radical prostatectomy (6 to 8 weeks after study injection).
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Postoperative Prostate-Specific Antigen (PSA)
Tidsramme: 6 to 8 weeks after radical prostatectomy and during follow-up through 36 months.
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Serum PSA levels following radical prostatectomy.
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6 to 8 weeks after radical prostatectomy and during follow-up through 36 months.
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Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Time to Biochemical Recurrence
Tidsramme: Up to 36 months after radical prostatectomy.
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Time from radical prostatectomy to biochemical recurrence as defined by postoperative PSA progression.
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Up to 36 months after radical prostatectomy.
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Brian Miles, MD, Houston Methodist Urology, Houston Methodist Research Institute
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Genitale sygdomme
- Genitale neoplasmer, mandlige
- Urogenitale neoplasmer
- Neoplasmer efter sted
- Neoplasmer
- Kønssygdomme, mandlige
- Prostatasygdomme
- Mandlige urogenitale sygdomme
- Prostatiske neoplasmer
- Aminosyrer, peptider og proteiner
- Proteiner
- Biologiske faktorer
- Hydrolaser
- Enzymer
- Enzymer og coenzymer
- Botulinumtoksiner
- Metalloendopeptidaser
- Endopeptidaser
- Peptidhydrolaser
- Metalloproteaser
- Bakterielle proteiner
- Bakterielle toksiner
- Toksiner, biologisk
- Botulinumtoksiner, type A
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- Pro00046310
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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