Prostate Cancer
Conditions
Keywords
Prostate Cancer, High Intensity Focused Ultrasound, Magnetic Resonance guided Focused Ultrasound, Non-invasive therapy, Focal Disease
Brief summary
Since prostate specific antigen (PSA) was introduced as a clinical screening tool for prostate cancer, more men are diagnosed with small foci of cancers instead of the advanced disease. The present choice of treatment for men with localized prostate cancer lies between active surveillance and radical therapy. Thus, the option of treating only the cancer within the prostate gland and sparing the non-cancerous tissue is quite appealing, yet very controversial. At present there are no consistent scientific data on focal therapy and its major effectiveness. Focal therapy for prostate cancer is defined as therapy that selectively ablates known disease while preserving existing functions, with the overall aim of minimizing lifetime morbidity without compromising life expectancy. The aim of the investigators study is to test if Magnetic Resonance guided Focused Ultrasound ablation can determine non-invasive necrosis of focal, locally non-advanced prostate cancer. The study i designed as Phase 1, treatment & resection protocol. With this project the investigators further aim to evaluate the safety and identify side effects of Magnetic Resonance guided Focused Ultrasound in treating focal prostate cancer. This design will also expand knowledge of the effect of Magnetic Resonance guided Focused Ultrasound onto peri-prostatic environment and to determine if surgery can safely be adopted after this non-invasive treatment.
Interventions
DEVICEExAblate 2100; InSightec
Patients with biopsy proven locally non-advanced T2 prostate cancer identified at 3T MR examination including dynamic contrast enhanced (DCE-with time to peak and mean transit time evaluation) and candidate to radical prostatectomy will undergo Magnetic Resonance guided Focused Ultrasound (MRgFUS) ablation. The procedure is carried out either under general anesthesia or spinal block. MR images allow correct identification of the target as well as vital structure to avoid during energy delivery. Treatment safety and efficacy is monitored in real time using MR thermometry. Adjustments of energy direction and intensity can be made according to the real time monitoring. Pre- and post-ablative MR examinations will serve to analyze differences of DCE features of the neoplastic tissue; therapy-induced alterations will also be compared to histopathology findings from whole section prostate specimens
Sponsors
University of Roma La Sapienza
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
40 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patient of age between 40 to 85 * Patient with organ-confined Pca (cT1c and cT2a, N0, M0), diagnosed with TRUS biopsy (min:12 cores) * Patient with PSA ≤ 10 ng/mL * Gleason score 6 (3+3) or max 7 (3+4) * Up to two (2) MR identifiable lesions * No definite evidence of extracapsular extension
Exclusion criteria
* Patient under medications that can affect PSA for the last 3 months prior to MRgFUS treatment (Androgen Deprivation Treatment; alpha reductase inhibitors) * Any rectal pathology, anomaly or previous treatment * Identified calcification of 2 mm or more in largest diameter neighboring the rectal wall * Bladder cancer * Seminal vesicle/lymph node * Prostate with multiple cystic lesions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety | One year | Measure of expected or UN-expected adverse events |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy | 18 months | Measure of ablated area in terms of necrosis vs residual tumor |
Countries
Italy
Outcome results
None listed