Patient case: 81-year-old male with Prostate cancer. Genetic variant: PTEN Inactivating. Other conditions: Hypertension, Depression.

Clinical trial: Ultrasound in Treating Patients With Prostate Cancer Confined to the Prostate

Summary: RATIONALE: Highly focused ultrasound energy may be able to kill cancer cells by heating the tumor without affecting the surrounding tissue.
  PURPOSE: Phase I trial to study the effectiveness of focused ultrasound energy in treating patients who have prostate cancer that has not spread beyond the prostate.

Detailed description: OBJECTIVES:
  -  Determine the ability of Sonablate to focus ultrasonic waves for the purpose of selectively destroying prostate cancer tissue, with resultant drop in PSA levels to below 0.5 ng/mL and negative biopsy for cancer cells, in patients with organ-confined prostate cancer.
  OUTLINE: This is a multicenter study.
  A probe is inserted into the rectum. High-intensity focused ultrasound (HIFU) energy using the Sonablate system is delivered to the prostate tissue over approximately 2-3 hours. Patients with residual cancer lesion (by biopsy), PSA greater than 0.5 ng/mL or increasing PSA levels taken at least 2 months apart, visible prostate tissue on ultrasound, and no local or distant metastases after day 90 undergo retreatment with HIFU.
  Patients are followed at 2, 14, 30, 90, and 180 days.
  PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed organ-confined prostate cancer (clinical stage T1 or T2 only)
  -  Pretreatment prostate weight less than 40 g
  -  Gleason score no greater than 7
  -  PSA no greater than 10 ng/mL
  -  No significant intravesical median lobe (greater than 2 cm) on ultrasound
  -  Able to visualize prostate gland adequately on transrectal ultrasound imaging
  -  No prostate calcification greater than 5 mm
  -  No metastases by bone scan
  PATIENT CHARACTERISTICS:
  Age:
  -  40 to 80
  Performance status:
  -  Not specified
  Life expectancy:
  -  Not specified
  Hematopoietic:
  -  Not specified
  Hepatic:
  -  No bleeding disorder as determined by abnormal PT and PTT
  Renal:
  -  No active urinary tract infection
  -  No history of urinary bladder neck contracture
  Other:
  -  No prior allergy to latex
  -  No Anesthesia Surgical Assignment category IV or greater
  -  No interest in future fertility
  -  No history of inflammatory bowel disease
  -  No other concurrent major debilitating illness
  -  No other prior or concurrent malignancy except skin cancer
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  No prior biologic therapy for prostate cancer
  Chemotherapy:
  -  No prior chemotherapy for prostate cancer
  Endocrine therapy:
  -  At least 3 months since prior hormonal therapy (including finasteride) for prostate cancer
  Radiotherapy:
  -  No prior radiotherapy for prostate cancer
  Surgery:
  -  No prior transurethral resection of prostate
  -  No prior urethral stent
  -  No prior major rectal surgery
  Other:
  -  No prior cryotherapy for prostate cancer
  -  No prior thermotherapy
  -  No other prior therapy for prostate cancer
  -  No concurrent warfarin or other anticoagulant

Relevance to patient case: not relevant