NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer.

Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Prostatectomy*/adverse effects ; Prostatectomy*/methods ; Prostatic Neoplasms*/pathology ; Prostatic Neoplasms*/surgery ; Robotic Surgical Procedures*/adverse effects ; Robotic Surgical Procedures*/methods; Erectile Dysfunction/etiology ; Humans ; Male ; Margins of Excision ; Multicenter Studies as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Urinary Incontinence/etiology

Background: Robotic radical prostatectomy (RARP) is a first-line curative treatment option for localized prostate cancer. Postoperative erectile dysfunction and urinary incontinence are common associated adverse side effects that can negatively impact patients' quality of life. Preserving the lateral neurovascular bundles (NS) during RARP improves functional outcomes. However, selecting men for NS may be difficult when there is concern about incurring in positive surgical margin (PSM) which in turn risks adverse oncological outcomes. The NeuroSAFE technique (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) can provide real-time pathological consult to promote optimal NS whilst avoiding PSM.
Methods: NeuroSAFE PROOF is a single-blinded, multi-centre, randomised controlled trial (RCT) in which men are randomly allocated 1:1 to either NeuroSAFE RARP or standard RARP. Men electing for RARP as primary treatment, who are continent and have good baseline erectile function (EF), defined by International Index of Erectile Function (IIEF-5) score > 21, are eligible. NS in the intervention arm is guided by the NeuroSAFE technique. NS in the standard arm is based on standard of care, i.e. a pre-operative image-based planning meeting, patient-specific clinical information, and digital rectal examination. The primary outcome is assessment of EF at 12 months. The primary endpoint is the proportion of men who achieve IIEF-5 score ≥ 21. A sample size of 404 was calculated to give a power of 90% to detect a difference of 14% between groups based on a feasibility study. Oncological outcomes are continuously monitored by an independent Data Monitoring Committee. Key secondary outcomes include urinary continence at 3 months assessed by the international consultation on incontinence questionnaire, rate of biochemical recurrence, EF recovery at 24 months, and difference in quality of life.
Discussion: NeuroSAFE PROOF is the first RCT of intra-operative frozen section during radical prostatectomy in the world. It is properly powered to evaluate a difference in the recovery of EF for men undergoing RARP assessed by patient-reported outcome measures. It will provide evidence to guide the use of the NeuroSAFE technique around the world.
Trial Registration: NCT03317990 (23 October 2017). Regional Ethics Committee; reference 17/LO/1978.
(© 2022. The Author(s).)

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19661 United Kingdom CRUK_ Cancer Research UK

Keywords: Frozen section; Nerve sparing; NeuroSAFE; Potency; Prostate cancer; Protocol; Randomised controlled trial; Robotic prostatectomy

ClinicalTrials.gov NCT03317990

Date Created: 20220722 Date Completed: 20220726 Latest Revision: 20240210

20240210

PMC9306247

10.1186/s13063-022-06421-7

35869497