Assessing the Potential for Reduced Toxicity Using Focal Brachytherapy in Early Stage, Low Volume Prostate Cancer

Study Overview
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Brief Summary
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The purpose of this study is to see what side effects a type of radiation treatment called focal brachytherapy has in treating early stage prostate cancer. The study is also looking at how useful focal brachytherapy will be in treating prostate cancer. Additionally, the investigators would like to see how this type of treatment impacts quality of life.

Official Title
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Phase II Study Assessing the Potential for Reduced Toxicity Using Focal Brachytherapy Early Stage, Low Volume in Prostate Cancer

Conditions
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Prostate Cancer

Intervention / Treatment
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* Other: Prostate Biopsy, Focal Brachytherapy , Assessment of QOL


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men ≥ 21 years of age with a life expectancy estimated to be > 10-years. Diagnosis of adenocarcinoma of the prostate confirmed by MSKCC or participating site pathology review. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 Prostate cancer clinical stage T1c-T2a PSA < 10ng/mL (this will be the PSA level prompting the prostate biopsy) MRI evidence of one-sided disease performed within 3 months of registration Prostate size <60 cc at time of treatment- if the prostate is larger, hormonal therapy is allowed to achieve the required size Screening biopsy parameters: Minimum of 10 biopsy cores Gleason grade 7 in two cores or less, with no primary Gleason grade 4 or 5 in any cores Unilateral cancer (only right-sided or left-sided, not bilateral) No more than 50 % cancer in any one biopsy core No more than 25 % of cores containing cancer Repeat transrectal or transperineal prostate biopsy that must meet the following parameters: Minimum of 12 biopsy cores Unilateral cancer (only right-sided or left-sided, not bilateral) Gleason grade 7 in two cores or less, with no primary Gleason grade 4 or 5 in any cores No more than 50 % cancer in any one biopsy core No more than 25 % of cores containing cancer Subject Exclusion Criteria: Medically unfit for anesthesia Evidence or suspicion of extracapsular extension on MRI IPSS score > 18 Unable to receive MRI Prior radiotherapy for the current disease

Ages Eligible for Study
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Minimum Age: 21 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: Prostate Biopsy, Focal Brachytherapy , Assessment of QOL<br>This is a non-randomized, Phase II study examining the tolerance profile (primary endpoint) as well as the secondary endpoints of QOL changes, efficacy and the correlation of post-treatment MRI findings with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal brachytherapy. | Other: Prostate Biopsy, Focal Brachytherapy , Assessment of QOL<br>* A re-staging transrectal or transperineal ultrasound-guided prostate biopsy as currently performed at participating institutions. Focal brachytherapy will be performed at 8 weeks following the transrectal or transperineal biopsy or sooner if the patient has recovered from the repeat biopsy and the treating physician determines it is safe to proceed with treatment. The regions will be targeted with the prescription dose and receive 144 Gy of Iodine-125 (I-125). The quality-of-life assessment will focus on erectile function, urinary function, bowel function, and general health related quality of life. The patients will complete this assessment at baseline and then approximately 3 ± 1 months, 6 ± 1 months, 12 ± 2 months, 18 ± 2 months, and 24 ± 2 months after treatment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To Assess the Late Toxicity Outcomes | focal brachytherapy in patients with low risk prostate cancer This study will utilize the toxicity grading scale Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 | 6 months to 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To Evaluate the Local Tumor Control After Focal Brachytherapy | as measured by the ability to obtain all negative biopsy cores 12 and 24 months after completion of therapy in the hemi-gland of where the focal therapy was administered. All negative means no prostate cancer; | 12 and 24 months | 
| To Evaluate the Change From Baseline in QOL Indicators | Following focal brachytherapy in patients with early stage low volume localized prostate cancer. The scales to measure these domains were derived from the previously validated MSKCC Prostate-Health Related Quality of Life Questionnaire (PHRQOLQ | baseline and then approximately 3 ± 1 months, 6 ± 1 months, 12 ± 2 months, 18 ± 2 months, and 24 ± 2 months after treatment | 
| To Correlate Post-treatment MRI Findings With Post-treatment Biopsy Outcomes | Post-treatment MRI outcome is defined as a 3-level categorical variable: positive, negative and undetermined. Post-treatment biopsy outcome is defined as a binary variable: positive and negative. We will examine the correlation between the 12-month MRI and 12-month biopsy, and between the 24-month MRI and 24-month biopsy. The correlation will be assessed by a Fisher exact test. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Focal Brachytherapy, Endorectal coil MRI, Quality of Life, 11-056