Neoadjuvant Exisulind in Treating Patients Who Are Undergoing Radical Prostatectomy for Stage II or Stage III Prostate Cancer

OBJECTIVES:

Primary

• Compare the effect of neoadjuvant exisulind vs no neoadjuvant treatment on apoptosis in patients with stage II or III prostate cancer undergoing radical prostatectomy.

Secondary

• Determine the effect of this drug (preoperatively) on surrogate endpoint biomarkers (i.e., prostate-specific antigen, high-grade prostatic intraepithelial neoplasia, MIB-1, and DNA ploidy) in these patients.

OUTLINE: This is a nonrandomized, controlled study. Patients are assigned to 1 of 2 groups based on the treating physician.

• Control group: Patients undergo radical prostatectomy only.
• Treatment group: Patients receive oral exisulind once daily for 4 weeks. Patients then undergo radical prostatectomy.

Patients are followed at 1 month.

PROJECTED ACCRUAL: A total of 130 patients (65 per group) will be accrued for this study within approximately 10-12 months.

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the prostate

• Clinical stage T1c-3b, N0-X, M0
• Gleason score ≥ 6
• Planning to undergo pelvic lymphadenectomy and radical prostatectomy at Mayo Clinic Rochester

• Interval from biopsy to prostatectomy is at least 4, but no more than 14, weeks
• Selected patients of Dr. R. P. Myers who are undergoing prostatectomy during the enrollment period will be assigned to the control group* NOTE: *Additional historical controls may be selected from Dr. Myers' patients who underwent prostatectomy within the past 4 years

PATIENT CHARACTERISTICS:

Age

• 40 and over

Performance status

• ECOG 0-1

Life expectancy

• Not specified

Hematopoietic

• Not specified

Hepatic

• ALT normal (10-45 U/L)
• AST normal (12-31 U/L)
• Alkaline phosphatase normal (119-309 U/L)
• Bilirubin normal (0.1-1.0 mg/dL)
• No history of hepatitis, cirrhosis, or other hepatic dysfunction

Renal

• Creatinine < 1.5 mg/dL

Other

• Fertile patients must use effective contraception
• No hypersensitivity to sulindac (treatment group)

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No concurrent immunotherapy

Chemotherapy

• No other concurrent chemotherapy

Endocrine therapy

• No prior ablation (treatment group)
• No prior hormone replacement or antiandrogen therapy (e.g., testosterone, diethylstilbestrol, leuprolide, goserelin, flutamide, bicalutamide, finasteride, nilutamide, or megestrol)
• No concurrent antiandrogen therapy, luteinizing hormone-releasing hormone agonists, finasteride, or diethylstilbestrol

Radiotherapy

• No prior pelvic radiotherapy
• No concurrent radiotherapy

Surgery

• See Disease Characteristics

Other

• No prior treatment for prostate cancer before prostatectomy (control group)
• No concurrent cyclooxygenase-2 inhibitors
• No concurrent sulindac
• No concurrent nonsteroidal anti-inflammatory drugs except low-dose (no more than 325 mg/day) aspirin for cardiovascular prophylaxis