Trial of Modifications to Radical Prostatectomy

Study Overview
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Brief Summary
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This trial will evaluate whether the following aspect of surgical technique influence outcome: Lymph node dissection. In some patients, scans taken before surgery show that a lymph node has cancer. Surgeons make sure to remove those affect lymph nodes and all other lymph nodes in the area. However, it is not known whether removing lymph nodes helps prostate cancer patients whose scans do not show positive nodes. In this study, patients with clear scans will either receive a lymph node dissection or not.

Official Title
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A Randomized Trial of Modifications to Radical Prostatectomy

Conditions
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Prostate Cancer

Intervention / Treatment
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* Procedure: Lymph node template
* Procedure: Transverse versus vertical closure
* Drug: antibiotic prophylaxis
* Drug: Hemostatic Agent


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients do not have to be eligible for both modifications to be included in the study. Lymphadenectomy vs no lymphadenectomy: Patients 21 years or older scheduled for radical prostatectomy for treatment of prostate cancer with one of the consenting surgeons at MSKCC Hemostatic agent vs. no hemostatic agent Patients 21 years or older scheduled for minimally invasive radical prostatectomy for the treatment of prostate cancer with one of the consenting surgeons at MSKC Exclusion Criteria: Lymphadenectomy vs no lymphadenectomy Presence of positive/suspicious pelvic nodes on MRI, CT or PSMA scan (positive/suspicious defined as a pelvic node >15mm in short axis on CT or MRI, a PSMA avid node, or a node with abnormal morphology such as roundness or irregularity or loss of fatty hilum) Any prior pelvic radiation therapy used to treat prostate cancer Hemostatic agent vs. no hemostatic agent No additional exclusion criteria

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lymphadenectomy vs. no lymphadenectomy<br>In patients randomized to standard, only the nodal packet under the external iliac vein and above the obturator nerve will be dissected. For patients randomized to the modified template, the external iliac, hypogastric and obturator fossa nodal groups will be removed.No lymph nodes will be removed in patients randomized to the no PLND arm. | Procedure: Lymph node template<br>* Inclusion of the external iliac, hypogastric and obturator fossa nodal groups in the template undergoing a Radical Prostatectomy. Modifying the template for lymph node dissection may lead to removal of additional affected nodes, reducing the chance of recurrence. .No lymph nodes will be removed in patients randomized to the no PLND arm.<br>|
| Experimental: Transverse versus vertical closure of the port site incision (Closed as of 9/30/2021)<br> | Procedure: Transverse versus vertical closure<br>* Transverse versus vertical closure of the port site incision<br>|
| Experimental: One vs. three days of antibiotic prophylaxis (Closed as of 9/30/2021)<br> | Drug: antibiotic prophylaxis<br>* One vs. three days of antibiotic prophylaxis at catheter removal<br>|
| Experimental: Hemostatic agent vs. no hemostatic agent<br> | Drug: Hemostatic Agent<br>* For the patients randomized to routine indwelling HA agent use, the operating surgeon may choose to use either Surgicel™, Surgicel SNoW™, Arista™, FloSeal or surgeon's choice HA directed at the prostatic fossa, ligated dorsal vein complex, or neurovascular bundles. Because there is no standard HA or method of application, the surgeon will apply the HA according to the surgeon's experience and document both the HA used, and the location applied in the operative report. For patients randomized to no routine indwelling HA use, surgeons will only apply a HA if they are unable to achieve hemostasis using traditional means or feel it would be unsafe to complete the operation without using a HA for additional hemostasis. Providers in either arm may use HA as needed provided the intention is not to leave the HA indwelling.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient-reported hernia | Patient-reported hernia is a routine assessment on post-operative questionnaires completed by prostate cancer patients at MSKCC. The questionnaire asks about hernia near the surgical scar and if there has been a need for surgical repair of the hernia. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate whether a modification to the template for lymph node dissection reduces biochemical recurrence rates | Biochemical recurrence is defined as any postoperative PSA of 0.2 ng / mL or higher, or treatment with hormones, radiotherapy or chemotherapy starting six months or more after radical prostatectomy. | 2 years | 
| urinary tract infection (UTI) | urinary tract infection (UTI) within 10 days of catheter removal. We will use the CDC's definition of UTI: symptomatic UTI diagnosed in patients with positive urine cultures (≥100,000 microorganisms per cm3) and at least one of the following signs or symptoms with no other recognized cause: fever (>38oC), urgency, frequency, dysuria or suprapubic tenderness.50 UTI is routinely captured by clinical staff as a surgical complication. | within 10 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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radical prostatectomy, anastomotic suturing, lymph node dissection, 11-096