SmartTarget THERAPY

University College, London69 enrolled

Overview

The purpose of this study is to assess how accurately SmartTarget can direct high intensity focused ultrasound (HIFU) to a pre-defined area (cancer) in the prostate. The current standard methods for treating prostate cancer are directed to the whole gland - either surgery to remove it or radiotherapy. An alternative method is focal therapy. This is surgery that uses an energy source to ablate the cancer whilst preserving the normal healthy tissue. Prior to surgery prostate cancer can often be localised using MRI imaging and detailed prostate biopsy techniques. The difficulty is that during surgery it is very difficult to accurately locate the cancer on the live ultrasound images - to compensate surgeons will treat half or a quarter of the prostate to ensure that the cancer is treated. This may cause higher rates of side-effects. SmartTarget is an MRI to ultrasound fusion device that maps the pre-treatment MRI onto the live ultrasound during surgery. It then provides a target for the surgeons to treat during the operation. The results will measure if the area intended to treat was covered and if how accurate the treatment was by comparing the pre-treatment MRI with a 1 week post treatment scan

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Prostatic Neoplasms

Interventions

Eligibility

Sex: MALE

Medical Language ↔ Plain English

Inclusion Criteria: 1. Histological diagnosis of prostate cancer (PSA \</=15ng/ml, Gleason score \</=4+3, and radiological stage \</=T3aNoMo) 2. Prostate biopsy concordant with mpMRI lesion (template transperineal or MRI-targeted biopsy only) 3. Discrete lesion on mpMRI scoring 3, 4 or 5 on radiological scale of suspicion 4. mpMRI carried out according to European Society of Uro-Radiology guidelines at 1.5T or 3T 5. An understanding of the English language sufficient to understand written and verbal information about the trial and consent process 6. Signed informed consent Exclusion Criteria: 1. No lesion on mpMRI 2. Bilateral lesions on mpMRI 3. mpMRI undertaken over 6 months prior to visit 1 4. Contralateral Gleason \>/=3+4 and/or Maximum Cancer Core Length Involvement \>/=6mm 5. Men who have taken any form of hormones (except 5-alpha reductase inhibitors) within the last 6 months 6. Prior immunosuppression or predefined immunosuppressed state 7. An irreversible coagulopathy predisposing to bleeding 8. Unable to undergo transrectal ultrasonography 9. Previous radiation therapy to the pelvis 10. Previous HIFU, cryosurgery, thermal, irreversible electroporation, radiofrequency or microwave therapy to the prostate. 11. Men with evidence of metastatic disease or nodal disease outside the prostate on bone scan or cross-sectional imaging 12. Men not fit for major surgery as assessed by a consultant anaesthetist 13. Men who are unable to give informed consent

Outcomes

Primary Outcomes

Target Ablation

The ability of SmartTarget-directed focal HIFU therapy to ablate an intended target within the prostate, as measured by the proportion of men in whom complete ablation of the target region is achieved. Complete or incomplete ablation is determined by a comparative assessment of the pre-therapy and one week post-therapy contrast-enhanced MRIs by an expert radiologist.

Time frame: 1 week post treatment

Secondary Outcomes

Accuracy

The accuracy of SmartTarget guided focal HIFU measured by the relative treatment volume and relative ablation volume on the one week post treatment.

Time frame: 1 week post treatment

Length of the procedure

The efficiency and clinical usability of the SmartTarget device as measured by the: Length of the procedure The time taken during the procedure using SmartTarget, including: The total prostate computer model generation time The total time taken to register (fuse) MRI and ultrasound image data and the number of times an image registration is performed using SmartTarget (the re-registration rate) SmartTarget failure rate

Time frame: intraoperative

Quality of Life

To assess how this treqatment strategy impacts on quality of life as measured using validated questionnaires at 6 weeks and 3 months post treatment. IPSS IIEF EQ5D - 5L

Time frame: 6 weeks and 3 months