Bariatric Arterial Embolization for Men Starting Hormones for Prostate Cancer

Study Overview
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Brief Summary
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The standard of care for obese men starting Androgen deprivation therapy (ADT) is physician based dietary and exercise counseling. Interventions to lessen the harmful effects of ADT are needed yet have been limited. Exercise is one strategy that has been attempted however there is conflicting data as to whether or not exercise effectively improves body mass, results in sustained weight loss, improvements in metabolic risk profiles including glucose tolerance and lipid profiles in men starting ADT, or has any effect of progression of cancer. Dietary interventions have been attempted without clear improvement in weight, metabolic factors, quality of life or cancer progression. Bariatric arterial embolization (BAE), given it results in weight loss in obese men and women without cancer, may be able to stave off the harmful side effects of ADT by inducing weight loss. Therefore, the investigators hypothesize that Bariatric Arterial embolization (BAE), done prior to initiation of ADT, will mitigate the weight gain and metabolic side effects associated with ADT, by inducing weight loss of at least 5% in obese men with biochemical recurrent prostate cancer starting ADT. The primary objective is to determine if BAE, done prior to ADT initiation in obese men (with obesity related comorbid condition) with biochemically recurrent prostate cancer, can induce 5% or greater weight loss at 6 months.

Official Title
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BASH-PC: Bariatric Arterial Embolization for Men Starting Hormones for Prostate Cancer

Conditions
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Prostate Adenocarcinoma, Obesity, Morbid

Intervention / Treatment
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* Device: Bead Block 300-500 um
* Behavioral: Weight Management
* Drug: Lupron


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willing and able to provide written informed consent and HIPAA authorization for the release of personal health information (HIPAA authorization will be included in the informed consent) Males aged 18 years of age and above Histological proof of adenocarcinoma of the prostate Non-metastatic disease by computed tomography (CT), magnetic resonance imaging (MRI) or Nuclear medicine (NM) bone scan. Patients must have CT abdomen/pelvis with contrast prior to enrollment. Metastatic disease may be permitted if NOT starting on any concomitant therapy (ie chemotherapy, anti-androgens) Prior local therapy with prostatectomy or radiotherapy (including brachytherapy) or both BMI >30 kg/m2 with a concurrent obesity related comorbidity Obesity related comorbidity is defined as: hypertension (resting blood pressure >130/80 millimeters of mercury (mmHg) or being on medication to treat high blood pressure50), coronary artery disease (defined as prior myocardial infarction, elevated coronary artery calcium score, positive stress test history), dyslipidemia (triglyceride level of >150mg/dL or being on medicine to treat high triglycerides; HDL < 40mg/dL or being on medicine to treat cholesterol)51, diabetes (fasting glucose >126mg/dL, A1c > 6.5% or on medication for diabetes)52, pre-diabetes (fasting plasma glucose 100-125mg/dL)52, elevated waist circumference (>40 inches in men), obstructive sleep apnea, arthritis, or non-alcoholic steatohepatitis. Prior salvage or adjuvant radiation therapy is allowed but must have been completed at least 3 months prior to enrollment Non-castrate levels of testosterone (>50 ng/dL required) Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 at screening Vascular anatomy (including celiac, hepatic and gastric arteries) that in the opinion of the interventional radiologist is amenable to bariatric embolization as assessed on 3D CT angiography Participants must have normal organ and bone marrow function measured within 28 days prior to administration of study treatment as defined below: Hemoglobin ≥ 10.0 g/dL with no blood transfusion in the past 28 days Absolute neutrophil count (ANC) ≥ 1.0 x 109/L Platelet count ≥ 50 x 109/L Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) Aspartate aminotransferase (AST) / Alanine aminotransferase (ALT) < 2.5 x institutional upper limit of normal Estimated Glomerular filtration rate (GFR) >60ml/min Exclusion Criteria: Prior hormonal therapy within 12 months of enrollment Planned concurrent cytotoxic chemotherapy or antiandrogens (ex. bicalutamide, abiraterone acetate, enzalutamide or any investigational agent). Contraindication to the use of leuprolide, such as a previous hypersensitivity reaction to an Luteinizing hormone-releasing hormone (LHRH) analogue or any of the excipients in the leuprolide injection Prior history of gastric, pancreatic, hepatic and/or splenic surgery Prior radiation therapy to the upper abdomen (pelvic radiation is not an exclusion) Prior embolization to the stomach, spleen or liver Cirrhosis or known portal venous hypertension Active peptic ulcer disease or significant risk factors for peptic ulcer disease including daily NSAID use or daily smoking Hiatal hernia >5cm in size Active h.pylori infection (patients will be required to have negative h.pylori testing) Weight >400 pounds or BMI >45kg/m2 Known aortic arch pathology such as aneurysm or dissection Major comorbidity that precludes procedure including significant cardiovascular disease or peripheral arterial disease including the following: Myocardial infarction within 6 months before screening Unstable angina within 3 months before screening New York Heart Association class III or IV congestive heart failure or a history of New York Heart Association class III or IV congestive heart failure unless a screening echocardiogram or multi-gated acquisition scan performed within 3 months before the randomization date demonstrates a left ventricular ejection fraction ≥ 45% History of clinically significant ventricular arrhythmias (eg, sustained ventricular tachycardia, ventricular fibrillation, torsades de pointes) Uncontrolled hypertension as indicated by a minimum of 2 consecutive blood pressure measurements showing systolic blood pressure > 170 mm Hg or diastolic blood pressure > 105 mm Hg at screening Peripheral arterial stenting or bypass procedure within 6 months before screening Active claudication Diabetes with A1c >7% or requiring medication other than metformin Known gastric motility dysfunction Preexisting chronic abdominal pain Positive stool occult study Inflammatory bowel disease Known history of allergy to iodinated contrast media American Society of Anesthesiology (ASA) physical status classification system Class 4 of 5 (very high risk surgical candidates: class 4 = incapacitating disease that is a constant threat to life) at the time of screening for enrollment Any condition in which the principle investigator feels participation in the trial would put the patient and undue risk

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Diet and exercise with BAE<br>After enrollment in the clinical trial, all men will be enrolled in diet and exercise counseling through the weight management program for a total of 4 weeks. If participants lose >5 pounds of total body weight from weight management alone in the first 4 weeks, these participants will be excluded from study and will not undergo BAE but will be encouraged to continue with weight management. Those still enrolled will undergo BAE. Within 7 days of BAE, men will be given ADT (lupron subcutaneous injection). | Device: Bead Block 300-500 um<br>* These patients will undergo embolization with 300-500µm Bead Block particles.<br>Behavioral: Weight Management<br>* All participants will be enrolled in weight management through the Johns Hopkins Weight Management Center. During weeks -4 through 0, participants will be required to go to weekly visits. Weight management will include counseling on diet, exercise and behavior change. Food programs, pharmacotherapy and other procedures will not be utilized.<br>Drug: Lupron<br>* 22.5 mg will be given as a single intramuscular or subcutaneous injection once every 12 weeks according to the standard of care for prostate cancer. If leuprolide acetate, 22.5 mg for 3-month administration is not available, a suitable substitute may be allowed upon approval by the principle investigator<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who experience at least 5 percent weight loss | Number of participants who experience at least 5 percent weight loss at 6 months after BAE. | At 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of adverse events | Number of adverse events will be assessed to determine if there are any increased adverse events in men with prostate cancer undergoing BAE. | Up to 6 months | 
| Change in Blood Pressure | Blood pressure (mmHg) will be assessed for changes over the specified time points. | Baseline, weeks 4, 8, 12, 16, 20, 24, 36 and 48 | 
| Change in Respiratory Rate | Respiratory rate in breaths per minute will be assessed for changes over the specified time points. | Baseline, weeks 4, 8, 12, 16, 20, 24, 36 and 48 | 
| Change in Oxygen saturation | Oxygen saturation (percentage) will be assessed for changes over the specified time points. | Baseline, weeks 4, 8, 12, 16, 20, 24, 36 and 48 |