Safety Study of MRI-guided Transurethral Ultrasound Ablation of Prostate Tissue to Treat Localized Prostate Cancer

Study Overview
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Brief Summary
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This study is to evaluate that the magnetic resonance imaging (MRI)-guided transurethral ultrasound therapy system is safe and feasible to ablate prostate tissue in men with localized prostate cancer.

Detailed Description
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Profound Medical Inc. has developed a novel technology called the MRI-guided transurethral ultrasound therapy system. The technology is developed for patients with organ confined prostate cancer. The therapeutic endpoint of this technology is thermal coagulation of prostate tissue. The treatment is conducted completely within an MRI suite, which enables real-time temperature images of the heated region to be acquired as the ultrasonic treatment is delivered. Using MRI thermometry during treatment, dynamic temperature feedback control over the intensity of the ultrasound beams and rotation of the Ultrasound Applicator can shape the pattern of thermal coagulation accurately and precisely in the prostate gland, thereby reducing the risk of possible damage to important surrounding anatomy such as the rectum, urinary sphincters, neurovascular bundles and pelvic bone. This coagulation method, therefore, has the potential to have lower complication rates than conventional therapies.

Official Title
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Phase 1 Study: A Prospective, Multi-center, Single Arm Study - Evaluation of the Safety and Feasibility of MRI-guided Transurethral Ultrasound Therapy for the Ablation of Prostate Tissue in Patients With Localized Prostate Cancer

Conditions
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Prostate Cancer

Intervention / Treatment
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* Device: MR-Guided Transurethral US Ablation of Prostate Tissue


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male, age ≥65 Patient with low-risk, early-stage organ-confined prostate cancer (Stage T1c or T2a, N0, M0). Gleason score 6 (3+3) Prostate-specific antigen (PSA) ≤ 10 ng/ml Eligible for MR imaging (DOC-10252) Meets the following criteria on pre-treatment transrectal ultrasound imaging: No cysts or calcifications > 1.0 cm in size No evidence of extraprostatic extension or seminal vesicle invasion Overall prostate size less than 5 cm in sagittal length and less than 7 cm in diameter Biopsy confirmed adenocarcinoma of the prostate, performed at least 6 weeks prior to and no more than 6 months prior to the scheduled treatment. Eligible for General Anesthesia, as defined in American Society of Anesthesiologists (ASA) Normal rectal anatomy and rectal mucosa on digital rectal examination Exclusion Criteria: Bleeding disorder Abnormal coagulation and current anticoagulant therapy. Acute or chronic Urinary Tract Infection Interest in future fertility History of allergy relevant medication or other History of any other malignancy other than skin cancer Patients with peripheral arterial disease with intermittent claudication or Leriches Syndrome Prior treatment of the prostate gland Prior treatment with 5 alpha reductase inhibitor allowed (not as prostate cancer treatment or prevention) as long as drug has been stopped for minimum 3 months History of any major rectal or pelvic surgery History of ulcerative colitis or other chronic inflammatory conditions affecting rectum History of documented clinical prostatitis requiring therapy within previous 6 months History of urethral and bladder outlet disorders, including urethral stricture disease, urethral diverticulae, bladder neck contracture, urethral fistulae which had required prior urethrotomy, urethral stenting, urethroplasty or chronic indwelling urethral catheter Patients with artificial urinary sphincter or any penile implant (metallic or non-metallic) Neurologic bladder disorders Untreated bladder stones History of acute urinary retention Confirmed or suspected bladder cancer Urinary sphincter abnormalities Active untreated gross hematuria for any cause Post Void Residual (PVR) bladder volume > 250 mL Obstructing median lobe enlarged out of proportion to the rest of the prostate and protruding significantly into the bladder Additional exclusion criteria on file....

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 75 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: MR-Guided Transurethral US Ablation<br>MR-Guided Transurethral US Ablation of Prostate Tissue | Device: MR-Guided Transurethral US Ablation of Prostate Tissue<br>* The technology is developed to treat patients with organ confined prostate cancer. The therapeutic endpoint of this technology is thermal coagulation of prostate tissue.<br>* Other names: Prostate Ablation Device: PAD-105;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety - Evaluate the Frequency of Treatment Related Adverse Events | All reported adverse events were recorded. The frequency was measured as the number of study participants who experienced a treatment/device related adverse event after receiving treatment delivery with PAD-105, the investigational device. | 12 months from the Treatment Date | 
| Safety - Evaluate the Severity of Treatment Related Adverse Events | Severity of treatment/device related adverse events were evaluated in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) standard (version 4), published by the National Cancer Institute (NCI). There was no intraoperative complication, no rectal injury or fistula and no severe urinary incontinence. No Grade 4 (G4) or higher adverse events and only one attributable Grade 3 (G3) event; reported below. The common and significant Grade 1 (G1) and Grade 2 (G2) genitourinary events have also been reported. | 12 months from the Treatment Date | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility - Evaluate the Effectiveness of the Investigational System to Thermally Coagulate Prostate Tissue Conforming to the Target Volume With a High Degree of Accuracy and Precision | Conformal thermal coagulation of prostate tissue will be determined quantitatively using measures of targeting accuracy which compare the spatial difference between the target volume and target temperature isotherm determined from MR thermometry images acquired during treatment. | On Treatment Date | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prostate Cancer, High intensity transurethral ultrasound ablation, MRI-guided, Minimally invasive, Real-time temperature feedback control