Study of Prostate Perfusion Before Embolization in Patients With Symptomatic Prostate Adenoma

Study Overview
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Brief Summary
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Over the last 5 years, prostate embolization has developed as a treatment for symptomatic prostate adenoma. This long, complex procedure is effective in 80% of cases. Currently there are no means of better selecting patients to avoid this long procedure in non-responders. The hypothesis is that prostate perfusion parameters are correlated with the efficacy of embolization. Studying these prostate perfusion parameters in perfusion CT and evaluating prostate Iodine load in dual energy computed tomography will make it easier to select those patients who are most likely to respond.

Detailed Description
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The hypothesis is that there are two types of prostate vascularization in patients with symptomatic prostate adenoma: prostates mainly vascularized by large caliber prostate arteries with high flow, for which perfusion parameters in favor of hyper-perfusion will be found. In this case, prostate artery embolization will be effective; prostates vascularized by a network of collaterals, with low flow-rates, for which perfusion parameters in favor of hypo-perfusion will be found. In this case, prostate artery embolization will not be very effective. The purpose of this study is to investigate the association between prostate perfusion parameters (peak time, transit time, blood volume, capillary permeability) and the clinical efficacy of prostate embolization at 3 months. These perfusion parameters could become new biomarkers leading to better selection of patients eligible for efficient prostate embolization, in order to avoid a considerable treatment with no benefit for certain patients and thus limit their global exposure to X-rays during care. Prior to this prospective study on patients with symptomatic benign prostate hypertrophy, a preliminary experimental study will be performed on a perfusion phantom in order to better understand the differences in the calculation of perfusion parameters according to the three main algorithms used. This will lead to optimization of the prostate perfusion protocol for the scanner: computed tomography acquisition parameters (kilovoltage, Milliamps per second) and therefore the X-ray dose delivered to patients, sampling frequency, and model to be used. The first results of this study have already led to modifications in scanner perfusion acquisition protocols for the initiation of clinical study.

Official Title
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Study of Prostate Perfusion Before Embolization in Patients With Symptomatic Prostate Adenoma. A Single-center Prospective Cohort Pilot Study to Determine the Predictive Factors of Clinical Efficacy Associated With a Prior Phantom Study.

Conditions
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Prostate Cancer

Intervention / Treatment
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* Other: Perfusion CT scanning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with symptomatic benign prostatic hypertrophy (prostate volume > 50, IPSS >7, QoL>2) or patients catheterized after acute retention of urine with failed catheterization. Creatinine clearance > 30 mL/min for one of the two Cockcroft-Gault/MDRD equations) Adult patients (≥18 years). Patients with an indication for prostate embolization. Patient with free and informed consent. Patient who have signed the consent form. Patient affiliated or beneficiary of a health insurance plan. Exclusion Criteria: Hypersensitivity to the active substance or to one of the excipients of the iodized contrast medium. Severe renal impairment with renal function <30mL/min. Contraindication to prostate embolization (aorto-iliac bypass) Patient participating in research defined as Category 1 Research Involving Human Subjects. Patient in an exclusion period as determined by another study. Patient under court protection, guardianship or curatorship. Patient unable to give consent. Patient for whom it is impossible to give informed information.

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: Patients benefitting from a perfusion CT scan before embolization<br>Prostatic perfusion parameters seem to be correlated with the effectiveness of embolization. Studying these prostatic perfusion parameters in perfusion CT and evaluating the prostatic Iodine load in dual energy CT will make it possible to better select responder patients. | Other: Perfusion CT scanning<br>* Abdominopelvic CT scan with perfusion and spectral analysis performed 7 days (± 5 days) before prostate embolization.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Catheterized patients: Removal of the urinary catheter at 3 months | Yes/No | Month 3 | 
| Non-catheterized patients: 25% decrease in the International Prostate Symptom Score | Yes/No | Month 3 | 
| Non-catheterized patients: one point improvement in the Global Quality of Life Score. | Yes/No | Month 3 | 
| MRI perfusion parameters : Capillary permeability | Measured in mL.mL tissue-1.min-1 | 7 - 14 days before embolization | 
| Scanner perfusion parameters : Capillary permeability | Measured in mL.mL tissue-1.min-1 | Day 0 (on the day of embolization) | 
| MRI perfusion parameters : Extracellular volume | Measured in mL.mL tissue-1 | 7 - 14 days before embolization | 
| Scanner perfusion parameters : Extracellular volume | Measured in mL.mL tissue-1 | Day 0 (on the day of embolization) | 
| MRI perfusion parameters : Blood volume | Measured in mL.mL tissue-1 | 7 - 14 days before embolization | 
| Scanner perfusion parameters : Blood volume | Measured in mL.mL tissue-1 | Day 0 (on the day of embolization) | 
| MRI perfusion parameters : Maximum slope | Measured in ml.min-1 | 7 - 14 days before embolization | 
| Scanner perfusion parameters : Maximum slope | Measured in ml.min-1 | Day 0 (on the day of embolization) | 
| MRI perfusion parameters : Time to peak | Measured in seconds | 7 - 14 days before embolization | 
| MRI perfusion parameters : Time to peak | Measured in seconds | Day 0 (on the day of embolization) | 
| Scanner perfusion parameters : Prostate iodine load at 80 s. | Measured in mgI.mg of prostate-1 | 7 - 14 days before embolization | 
| MRI perfusion parameters : Prostate iodine load at 80 s. | Measured in mgI.mg of prostate-1 | Day 0 (on the day of embolization) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Influence of flow rate on the scanner algorithm | The influence of flow rate on the scanner algorithm will be measured on the perfusion phantom model in mL.min-1. | 1 - 15 days before embolization. Preliminary stage on phantom. | 
| A. Correspondence between MRI and scanner: Capillary permeability | Measured in mL.mL tissue-1.min-1 | 1 - 7 days before embolization | 
| A. Correspondence between MRI and scanner: Extracellular volume | Measured in mL.mL tissue-1 | 1 - 7 days before embolization | 
| A. Correspondence between MRI and scanner: Blood volume | Measured in mL.mL tissue-1 | 1 - 7 days before embolization | 
| A. Correspondence between MRI and scanner: Maximum slope | Measured in mL.min-1 | 1 - 7 days before embolization | 
| A. Correspondence between MRI and scanner: Time to peak | Measured in seconds | 1 - 7 days before embolization | 
| A. Correspondence between MRI and scanner: 80-second iodine load | Measured in mgl.mg of prostate-1 | 1 - 7 days before embolization | 
| B. 4-D map Magnetic Resonance Imaging perfusion parameters : Volume of beads injected | Measured in mL | At the time of embolization | 
| B. Scanner perfusion parameters : Volume of beads injected | Measured in mL | At the time of embolization | 
| C. Influence of scanner acquisition parameters: kV | The influence of scanner acquisition parameters on the scanner algorithm will be measured on the the perfusion phantom model. | 1 to 15 days before embolization. Preliminary stage on phantom. | 
| C. Influence of scanner acquisition parameters: mAs | The influence of scanner acquisition parameters on the scanner algorithm will be measured on the the perfusion phantom model. | 1 to 15 days before embolization. Preliminary stage on phantom. | 
| C. Influence of scanner acquisition parameters: iterative reconstruction | The influence of scanner acquisition parameters on the scanner algorithm will be measured on the the perfusion phantom model. | 1 to 15 days before embolization. Preliminary stage on phantom. | 
| C. Blood volume | The perfusion parameter blood volume will be measured on the phantom in mL | 1 to 15 days before embolization. Preliminary stage on phantom. | 
| C. Maximum slope | The perfusion parameter maximum slope will be measured on the phantom in mL.min-1 | 1 to 15 days before embolization. Preliminary stage on phantom. | 
| C. Time to peak | The perfusion parameter time to peak will be measured on the phantom in seconds | 1 to 15 days before embolization. Preliminary stage on phantom. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prostate, Adenoma, Embolization