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Brief Title: Impact of Atorvastatin on Prostate Cancer Progression During ADT
Official Title: Impact of Atorvastatin on Prostate Cancer Progression After Initiation of Androgen Deprivation Therapy - Lipid Metabolism as a Novel Biomarker to Predict Prostate Cancer Progression
Study ID: NCT04026230
Brief Summary: This randomized double-blind placebo-controlled trial tests whether intervention with atorvastatin delays development of castration resistance compared to placebo during androgen deprivation therapy (ADT) for prostate cancer.
Detailed Description: Cholesterol-lowering statin drugs have been reported to lower proliferation activity in prostate cancer, delay occurrence of castration resistance and reduce the risk of prostate cancer death. Therefore, it is important to test statins' efficacy in addition to conventional prostate cancer treatment in a randomized, placebo-controlled trial. This phase 3 randomized double-blind placebo-controlled trial will explore whether intervention with atorvastatin delays prostate cancer progression i.e. development of castration resistance compared to placebo during androgen deprivation therapy (ADT) for metastatic or recurrent prostate cancer. Secondary objectives include exploring whether atorvastatin lowers prostate cancer-specific or overall mortality compared to placebo, and to demonstrate whether changes in serum lipid parameters predict disease recurrence and occurrence of adverse genomic changes predicting castration resistance among prostate cancer patients during ADT. The study recruitment target is 400 participants who start ADT as management of metastatic or recurrent prostate cancer. These men will be randomized 1:1 (200 + 200) to receive blinded study drug, either 80 mg of atorvastatin daily or placebo until disease recurrence i.e. development of castration resistance or for a maximum of five years. The study will be carried out in collaboration between urological departments of University Hospitals in Finland as a project of the national FinnProstata study group, Herlev University Hospital in Denmark, Vestfold and Telemark hospitals in Norway and the Tartu University Hospital in Estonia. Follow-up is continued until the primary end-point, development of castration resistance. After this the participants will be given the opportunity to voluntarily carry on with the blinded intervention for maximum time of ten year to observe effects on survival after development of castration resistance. Blinding will be lifted after the follow-up is complete for all study participants. Castration resistance is defined as prostate-specific antigen (PSA) progression (three consecutive rises of PSA measured at least 1 week apart with two \> 50% increases over the nadir and PSA \> 2 ng/ml) or radiological disease progression (appearance of two or more lesions in bone scan or soft tissue enlargement as per RECIST criteria) with serum testosterone at castrate level (\< 1.73 nmol/l; 50 ng/dl) during ADT.
Minimum Age: 18 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: MALE
Healthy Volunteers: No
Herlev and Gentofte Hospital, Herlev, , Denmark
Tartu University Hospital, Tartu, , Estonia
Helsinki University Hospital, Department of Urology, Helsinki, , Finland
Central Finland central hospital, Jyväskylä, , Finland
Kuopio University Hospital, Department of Urology, Kuopio, , Finland
Seinäjoki Central Hospital, Department of Surgery, Seinäjoki, , Finland
Tampere University Hospital, Tampere, , Finland
Turku University Hospital, Turku, , Finland
The Hospital of Telemark, Skien, , Norway
The Hospital of Vestfold, Tønsberg, , Norway
Name: Teemu Murtola, MD, PhD
Affiliation: Tampere University Hospital
Role: PRINCIPAL_INVESTIGATOR
Name: Otto Ettala, MD, PhD
Affiliation: Turku University Hospital
Role: STUDY_DIRECTOR
Name: Heikki Seikkula
Affiliation: Central Finland Central Hospital
Role: STUDY_DIRECTOR