Pilot Study to Investigate Magnetic Resonance (MR) Image Guided Focal Therapy in Prostate Cancer

Study Overview
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Brief Summary
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Background: The ability to treat early prostate cancer is still limited. Thermal ablation methods are being tested for focal prostate cancer therapy. Researchers want to improve on these methods. Objective: To understand if Transurethral UltraSound Ablation (TULSA) in combination with MRI guidance is useful to treat localized prostate cancer. Eligibility: English-speaking adults ages 18 and older with localized prostate cancer that can be seen on MRI and can be treated by thermal ablation. Design: Participants will be screened with the following: Medical history Physical exam Digital rectal exam Blood and urine tests Electrocardiogram Tumor biopsy Questionnaire to assess urinary tract symptoms MRI of the pelvis. The MRI scanner is a long, narrow tube. Participants will lie on a bed that moves in and out of the scanner. Participants may also be screened with the following: Echocardiogram Chest x-ray Bone scan Urodynamic studies to see how well the bladder, sphincters, and urethra hold and release urine MRI of the brain Transrectal ultrasound Computer tomography (CT) scan of the chest, abdomen, and pelvis. A CT scan is a series of x-ray images taken of parts of the body. Some screening tests will be repeated during the study. Participants will have the TULSA procedure. They will have an MRI for guidance. A small ultrasound applicator will be placed into their urethra. It uses heat to destroy the cancer areas in the prostate. It is controlled by a robotic arm. A cooling catheter will be placed into their rectum. Participants will use a urethral catheter for 1-7 days. Participants will have follow-up visits at 3, 6, 12, 18, 24, and 36 months.

Detailed Description
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Background: Prostate cancer is relatively slow growing, with doubling times for local tumors estimated at 2 to 4 years. Some prostate cancers prove to be small, low grade, and noninvasive and they appear to pose little risk to the life or health of the host. Recent patient series suggest that 20% to 30% of men undergoing radical prostatectomy have pathologic features in the radical prostatectomy specimen consistent with an insignificant or indolent cancer which poses little threat to life or health. We propose that participants with low volume and low grade disease can be best served with focal ablation of the visible prostate cancer without the side effects of urinary incontinence and erectile dysfunction associated with radiation therapy or radical surgery. Focal Therapy for prostate cancer has gained popularity however prior studies demonstrate a failure rate as high as 50% with a laser. Objective: To determine the feasibility of magnetic resonance image (MRI)-guided ultrasound-induced thermal therapy of biopsy-confirmed and MRI visible, prostate tumor(s) using the TULSA Thermal Therapy System (Profound Medical) Eligibility: Subjects with prostate cancer, amenable for ultrasound ablation Organ confined clinical T1c or clinical T2a prostate cancer, visible on MRI, and confirmed by prostate biopsy Adequate organ and marrow function Prostate-specific antigen (PSA) < 20 ng/ml Age >=18 years Design: Study testing feasibility and tolerability of ultrasound ablation of focal prostate cancer. It is anticipated that 15 participants will be accrued for this study.

Official Title
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Magnetic Resonance Image (MRI) Guided High Energy Ultrasound for Focal Prostate Cancer Ablation

Conditions
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Prostate Cancer

Intervention / Treatment
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* Device: TULSA-PRO


Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Subjects must have prostate cancer, amenable for ultrasound ablation defined as following: diagnosed by prostate biopsies consist of transrectal ultrasound-guided standard 12 core biopsy and biopsies of one or two MRI target lesions; Gleason Score <= 7; <= 4 cores positive in a standard 12 core biopsy and <= 4 cores positive on MRI target lesions biopsy where 2 cores are taken from each of the one or two MRI target lesions; histologically positive standard biopsy cores must be from the same location in the prostate as an MRI target lesion(s) and reviewed by NCI urologic pathologist. (Left / Right, Base, Mid-Gland, Apex). organ confined clinical T1c or clinical T2a prostate cancer that is visualized on MRI imaging. Note: Participants after prostate cancer treatment with local recurrence or residual tumor which is visible on MRI are eligible. PSA < 20 ng/ml. Adults (>= 18 years of age) Participants must have adequate organ and marrow function as defined below: Platelets >= 50,000/mcL Hemoglobin >= 8 g/dL ALT or AST <= 5 x ULN Measured or calculated creatinine clearance (CrCl) (eGFR may also be used in place of CrCl)* >= 30 mL/min/1.73 m^2 ALT (SGPT)=alanine aminotransferase (serum glutamic pyruvic transaminase); AST (SGOT)=aspartate aminotransferase (serum glutamic oxaloacetic transaminase); GFR=glomerular filtration rate; ULN=upper limit of normal. *Creatinine clearance (CrCl) or eGFR should be calculated per institutional standard. - Subjects must be able to understand and willing to sign a written informed consent document. EXCLUSION CRITERIA: The presence of 3 or more MRI visible lesions positive for prostate cancer on biopsy Targeted lesion ablation length from apex to base of >5 cm or lesion extending >3 cm from the urethra. Target ablative volume of greater than 100 ml. Presence of calcifications that would impede ultrasound transmission between the urethra and ablative target. The participant is unable to tolerate MRI (foreign body, i.e., pacemaker or other implanted device; claustrophobia; inability to tolerate rectal coil; etc.) The participant with the inability to follow up Acute urinary tract infection Lower urinary tract symptoms defined by an IPSS > 20 Participants with uncontrolled coagulopathies (including liver dysfunction, or untreated hereditary coagulopathies which have a standard of care treatment) per surgeon discretion based on bleeding risk. Other serious illnesses according to the PI: involving the cardiac, respiratory, CNS, renal, or hepatic organ systems, which would preclude study completion or impede the determination of causality of any complications experienced during the conduct of this study.

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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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1/Arm 1<br>Ultrasound ablation of focal prostate cancer | Device: TULSA-PRO<br>* Transurethral MR-Thermometry Guided Ultrasound Ablation of the Prostate<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| feasibility and tolerability | To determine the feasibility of magnetic resonance image (MRI)-guided ultrasound-induced thermal therapy of biopsy-confirmed and MRI visible, prostate tumor(s) using the TULSA Thermal Therapy System (Profound Medical) | 3, 6, 12, 18, 24, and 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| safety and tolerability | Address short- and long-term complication rates of study treatment by tabulating adverse events by grade according to CTCAE, and analyzing and reporting descriptively | 3, 6, 12, 18, 24, and 36 months | 
| changes in imaging and biopsy characteristics | Determine if focal ablation of MRI visible, biopsy-confirmed prostate cancer using the TULSA Thermal Therapy System (Profound Medical) platform can successfully ablate targeted prostate cancer lesions in >50% of participants | 3, 6, 12, 18, 24, and 36 months | 
| effect of thermal ablation on short- and long-term complication rates | Observe thermal damage on post-contrast MRI which extends into areas of the Rectum or Urethra; assess frequency of not completing the procedure | 3, 6, 12, 18, 24, and 36 months | 
| thermal damage | Observe thermal damage on post-contrast MRI which extends into areas of the Rectum or Urethra; assess frequency of not completing the procedure | 3, 6, 12, 18, 24, and 36 months | 
| outcome of TULSA ablation | Use descriptive statistical analysis to examine serial PSA, PSA density, changes in imaging and biopsy, International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM) | 3, 6, 12, 18, 24, and 36 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TULSA, Thermal Therapy System, PSA, Gleason Score