Evaluation Of Transperineal Ultrasound For Image Guidance In The Treatment Of Prostate Cancer in Men Following Prostatectomy
Condition: Prostate Cancer; Post-Prostatectomy
MeSH terms: Prostatic Neoplasms
Study type: Observational

Summary: 
      This study is being done to find out if transperineal ultrasound (TPUS) can help define the
      prostate bed for radiation treatment planning and improve upon current methods of image
      guidance for the treatment of prostate cancer. For the patient, TPUS involves the placement
      of an ultrasound probe on the perineum, the skin between the scrotum and anus, while they are
      lying on their back in the position they will receive their treatment. Image-guidance is
      required for the treatment of prostate cancer because the prostate bed shifts position
      depending on how full the bladder and rectum are. Image-guided radiation therapy has been
      done at Fletcher Allen Health Care for approximately three years. Most commonly,
      transabdominal ultrasound images are obtained every day and compared to an ultrasound that
      was done on the day of treatment planning. Adjustments in radiation field position can be
      done on a daily basis by comparing these images. Transperineal ultrasound has never been used
      for image-guidance. We completed two phases of an earlier study and have developed a TPUS
      device and process that allow us to get clear ultrasound pictures of the prostate gland, and
      now we would like to explore imaging the prostate bed left after radical prostatectomy.The
      TPUS has three potential advantages over the transabdominal method we currently use:

        1. Transabdominal ultrasound can be a challenge for some men. A full bladder helps us get
           clearer images, however it is difficult for some men with prostate cancer to comfortably
           keep a full bladder. It is also particularly difficult to get good images in larger men
           who have long distances from the skin surface to the prostate bed. TPUS is not dependent
           on a man having a full bladder and should be less dependent on the size of the man.

        2. TPUS images and the planning CT images can be acquired simultaneously. This is not
           possible with the abdominal probe because it gets in the way of the CT machine.
           Simultaneous imaging eliminates the possibility of the prostate bed shifting positions
           during the time between imaging studies.

        3. TPUS can be in place and acquire images during patient treatment (the abdominal probe
           gets in the way of the treatment machine) and may in the future allow us to watch the
           prostate bed during treatment. If we discover that we can accurately view the prostate
           bed in real time, TPUS may ultimately allow us to treat even smaller radiation fields
           and possibly decrease the risk of radiation complications.

      Patients in this study will be treated for their prostate cancer with the standard image
      guidance technique used at Fletcher Allen Health Care: transabdominal ultrasound. In
      addition, one TPUS scan will be acquired at the time of the initial simulation.

      To summarize, the two objectives of this study are:

        1. To determine if TPUS can acquire usable, clinically pertinent IGRT images of the
           prostate bed.

        2. To preliminarily compare TPUS images of the prostate bed to images obtained with CT and
           TAUS.
    


Intervention name(s): Transperineal Ultrasound
Intervention type(s): Device
Other intervention name(s): Elekta, Ltd. probe
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        University of Vermont Medical Center- Radiation Oncology Patient Prostate cancer w/
        prostatectomy
      
Keywords: Prostate cancer; Prostatectomy; Ultrasound; TPUS