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Observation or Radical Treatment in Patients With Prostate Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT00499174
Recruitment Status : Terminated (Not meeting accrual target.)
First Posted : July 11, 2007
Results First Posted : May 12, 2021
Last Update Posted : May 12, 2021
National Cancer Institute (NCI)
Cancer and Leukemia Group B
Eastern Cooperative Oncology Group
Southwest Oncology Group
Radiation Therapy Oncology Group
Institute of Cancer Research, United Kingdom
Information provided by (Responsible Party):
Canadian Cancer Trials Group ( NCIC Clinical Trials Group )

Brief Summary:

RATIONALE: Sometimes prostate tumours may not need treatment until they progress. In this case, observation may be sufficient. Radical treatments, such as radical prostatectomy or radiation therapy, may be effective in treating prostate cancer when it is first diagnosed. It is not yet known whether active surveillance is more effective than radical treatment as an initial intervention in favorable prognosis prostate cancer.

PURPOSE: This randomized phase III trial is studying active surveillance to see how well it works compared with radical treatment as an initial intervention in patients with favorable prognosis prostate cancer.

Condition or disease Intervention/treatment Phase
Prostate Cancer Procedure: conventional surgery Radiation: brachytherapy Radiation: external beam radiation therapy Procedure: Biopsies Not Applicable

Detailed Description:



  • To compare disease-specific survival of patients with favorable risk prostate cancer treated with radical prostatectomy or radical radiotherapy at the time of initial diagnosis vs active surveillance and selective intervention based on pre-specified biochemical, histological, or clinical progression criteria.


  • To compare overall survival, quality of life using the EPIC-26, RAND SF-12, and State-Trait Anxiety Inventory, distant disease-free survival, PSA relapse/progression after radical intervention, and initiation of androgen deprivation therapy between the two treatment arms.
  • To determine the proportion of patients on the active surveillance arm who receive radical intervention for prostate cancer.
  • To determine if PSA doubling-time prior to diagnosis predicts eventual outcome.
  • To determine if molecular biomarkers predict outcome.

OUTLINE: This is a prospective, randomized, multicenter study. Patients are stratified by treatment center, ECOG performance status (0 vs 1 or 2), disease stage (T1 vs T2), baseline PSA value (ng/mL or μg/L) (< 5.0 vs ≥ 5.0 and ≤ 10.0), and age (< 65 years vs ≥ 65 years). Patients are randomized to 1 of 2 arms.

  • Arm I: Patients undergo radical intervention (radical prostatectomy or radiotherapy [external-beam radiotherapy 5 days a week for 4-8 weeks; permanent prostate brachytherapy; or high-dose rate temporary brachytherapy], based on patient and physician preference).
  • Arm II: Patients undergo active surveillance with radical intervention at the time one or more pre-specified criteria (biochemical progression, histologic/grade progression, and/or clinical progression) are met.

Quality of life is assessed by the EPIC-26, RAND SF-12, and State Anxiety Inventory at baseline, periodically during study treatment, and after completion of radical treatment.

After completion of radical treatment, patients are followed every 6 months.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III Study of Active Surveillance Therapy Against Radical Treatment in Patients Diagnosed With Favourable Risk Prostate Cancer [START]
Actual Study Start Date : June 15, 2007
Actual Primary Completion Date : December 31, 2011
Actual Study Completion Date : January 10, 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
No Intervention: Active Surveillance
Active surveillance with radical intervention at the time one or more of the following occur: Biochemical progression; Grade progression; Clinical progression
Active Comparator: Radical Intervention
Radical prostatectomy or radiotherapy based on patient and physician preference
Procedure: conventional surgery
Radical prostatectomy

Radiation: brachytherapy
high dose rate temporary seed implant; permanent seed implant.

Radiation: external beam radiation therapy
3D conformal radiation therapy; intensity modulated radiation therapy.

Procedure: Biopsies
Periodic repeat biopsies

Primary Outcome Measures :
  1. Disease-specific Survival [ Time Frame: 5 years 6 months ]
    Time from the date of randomization to the date of death due to prostate cancer.

Secondary Outcome Measures :
  1. Overall Survival [ Time Frame: 5 years 6 months ]
    Time from randomization to the date of death due to any causes.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No


  • Histologically confirmed adenocarcinoma of the prostate

    • Diagnosed within 6 months prior to randomization
  • Patient has been classified as favorable risk as defined by the following:

    • Clinical stage T1b, T1c, T2a, or T2b at the time of diagnosis
    • Clinical (diagnostic biopsy) Gleason score ≤ 6
    • PSA ≤ 10.0 ng/mL
  • Physical examination, rectal examination, and transrectal ultrasound have been done within 6 months prior to randomization and radiographic studies, if indicated, are negative for metastasis
  • Patient is a suitable candidate for radical prostatectomy or radiotherapy


  • ECOG performance status 0, 1, or 2
  • Patient has a minimum life expectancy of > 10 years
  • In centers participating in the quality of life component of the study, the patient is able (i.e., sufficiently fluent) and willing to complete the quality of life questionnaires in either English or French
  • No history of other malignancies, except adequately treated non-melanoma skin cancer, adequately treated superficial bladder cancer, or other solid tumors curatively treated with no evidence of disease for ≥ 5 years from study randomization


  • No previous treatment for prostate cancer, including surgery (excluding biopsy and TURP), radiotherapy, or androgen deprivation therapy for greater than 3 months
  • No planned androgen therapy except in the context of radical therapy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00499174

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Canada, British Columbia
Clinical Research Unit at Vancouver Coastal
Vancouver, British Columbia, Canada, V5Z 1M9
Canada, Manitoba
CancerCare Manitoba
Winnipeg, Manitoba, Canada, R3E 0V9
Canada, Newfoundland and Labrador
Dr. H. Bliss Murphy Cancer Centre
St. John's, Newfoundland and Labrador, Canada, AIB 3V6
Canada, Nova Scotia
QEII Health Sciences Center
Halifax, Nova Scotia, Canada, B3H 1V7
Canada, Ontario
London Regional Cancer Program
London, Ontario, Canada, N6A 4L6
Ottawa Health Research Institute - General Division
Ottawa, Ontario, Canada, K1H 8L6
Odette Cancer Centre
Toronto, Ontario, Canada, M4N 3M5
Univ. Health Network-Princess Margaret Hospital
Toronto, Ontario, Canada, M5G 2M9
Canada, Quebec
CHUM - Hopital Notre-Dame
Montreal, Quebec, Canada, H2L 4M1
McGill University - Dept. Oncology
Montreal, Quebec, Canada, H2W 1S6
CHUQ-Pavillon Hotel-Dieu de Quebec
Quebec City, Quebec, Canada, G1R 2J6
Centre hospitalier universitaire de Sherbrooke
Sherbrooke, Quebec, Canada, J1H 5N4
Canada, Saskatchewan
Allan Blair Cancer Centre
Regina, Saskatchewan, Canada, S4T 7T1
Sponsors and Collaborators
NCIC Clinical Trials Group
National Cancer Institute (NCI)
Cancer and Leukemia Group B
Eastern Cooperative Oncology Group
Southwest Oncology Group
Radiation Therapy Oncology Group
Institute of Cancer Research, United Kingdom
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Study Chair: Laurence H. Klotz, MD Toronto Sunnybrook Regional Cancer Centre
Study Chair: Adam S. Kibel, MD Washington University Siteman Cancer Center
Study Chair: Martin G. Sanda, MD Beth Israel Deaconess Medical Center
Study Chair: Ian M. Thompson, MD The University of Texas Health Science Center at San Antonio
Study Chair: Richard Choo, M.D Mayo Clinic
Study Chair: Chris Parker, M.D Royal Marsden Hospital, Sulton, UK
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: NCIC Clinical Trials Group
ClinicalTrials.gov Identifier: NCT00499174    
Other Study ID Numbers: PR11
U10CA077202 ( U.S. NIH Grant/Contract )
CAN-NCIC-CTG-PR11 ( Registry Identifier: PDQ )
CALGB-140602 ( Other Identifier: CALGB Assigned Trial Code )
SWOG-PR11 ( Other Identifier: SWOG Assigned Trial Code )
CDR0000557348 ( Other Identifier: PDQ )
RTOG-0873 ( Other Identifier: RTOG )
ECOG-JPR.11 ( Other Identifier: ECOG Assigned Trial Code )
ICR-CTSU-ProSTART ( Other Identifier: CTSU )
First Posted: July 11, 2007    Key Record Dates
Results First Posted: May 12, 2021
Last Update Posted: May 12, 2021
Last Verified: May 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Canadian Cancer Trials Group ( NCIC Clinical Trials Group ):
stage II prostate cancer
adenocarcinoma of the prostate
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Prostatic Diseases