This is a single-arm Phase II clinical trial assessing the clinical efficacy of prostate specific membrane antigen (PSMA) PET/MR guided MR-LINAC based SBRT-SIB with planned accrual of 50 patients.
Localized prostate cancer can be treated in 5 sessions using a precise, targeted form of radiation known as stereotactic body radiation therapy (SBRT), with low toxicity. Despite these advances, overall outcomes for aggressive (high risk) prostate cancer remain poor, with 10-year recurrence-free survival of approximately 65% regardless of treatment modality. Recurrences are typically distant and carry poor prognosis, with 5 year survival of 25%. The investigators propose to utilize the latest advances in cancer imaging (PSMA Positron Emission Tomography (PET)/Magnetic Resonance Imaging (MR)) and radiation delivery (MR-guided radiation therapy with real-time adaptive planning), to deliver a personalized radiation treatment that targets the areas of greatest risk of recurrence in the prostate with improved precision, and as a result improve clinical outcomes for individuals with high risk prostate cancer. PSMA PET/MR is a novel imaging modality, not yet widely available, that augments the tissue detail provided by MR. The combination of PSMA PET with MR results in improved delineation of intraprostatic nodules and higher diagnostic accuracy for detection of metastatic disease compared to conventional imaging. PSMA PET/MR imaging data is readily transferable to a MR-based linear accelerator (MR-LINAC), a novel, innovative platform that allows direct visualization of the tumor during treatment, and permits real-time individualized correction for motion with online adaptive radiation planning.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Patients enrolling on the protocol will undergo prostate-specific membrane antigen (PSMA) Positron Emission Tomography (PET)/Magnetic Resonance(MR) prior to start of the radiation treatment planning process. PSMA tracer is administered by IV injection and PET images are acquired. Any patients found to have possible metastatic disease will undergo a standard of care confirmatory biopsy (if feasible) and receive treatment appropriate for their stage. The PSMA PET/MR scan will be performed prior to initiation of androgen deprivation therapy (ADT).
Patients will receive standard of care radiation therapy (SBRT)
Weill Cornell Medicine
New York, New York, United States
RECRUITINGClinical efficacy of prostate-specific membrane antigen (PSMA) Positron Emission Tomography (PET)/Magnetic Resonance(MR), MR-Linear Accelerator (LINAC) will be assessed by evaluating recurrence free survival
Evaluate the clinical efficacy of PSMA PET/MR guided, MR-LINAC-based SBRT- SIB in high-intermediate and high risk prostate cancer, as evaluated by the 2-year recurrence-free survival rate
Time frame: 24 months
Performance of PSMA PET/MR to MR alone at staging prostate cancer
Detection of metastatic disease on each scan will be recorded, with pathologic confirmation obtained. Detection of intraprostatic nodules will be recorded with pathologic confirmation obtained.
Time frame: Baseline
Performance of PSMA PET/MR to MR alone for identification of dominant intraprostatic nodules during radiation planning
The Dominant Intraprostatic Nodules (DIN) will be defined with radiologist assistance on MR alone, and subsequently PSMA PET/MR. The incidence of alterations in target will be recorded.
Time frame: Baseline
Compare imaging biomarkers of interest on MR and PSMA PET/MR as predictors of treatment response, versus biopsy of treatment response and PSA
Time frame: Baseline
Compare imaging biomarkers of interest on MR and PSMA PET/MR as predictors of treatment response, versus biopsy of treatment response and PSA
Time frame: 12 months
Change in Quality of life questionnaires (EPIC-26) will be assessed.
Expanded Prostate Cancer Index Composite (EPIC) short form questionnaire. The Expanded Prostate Cancer Index Composite (EPIC) is a comprehensive instrument designed to evaluate patient function and bother after prostate cancer treatment. Scores range from 0 to 100, lower scores indicate worse outcomes and higher EPIC scores represent better outcomes.
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Time frame: Baseline, 1month, 6months, 12 months, 18 months and 24 months.
Change in The American Urological Association (AUA) symptom score
The American Urological Association (AUA) has created this symptom index for understanding the severity of enlarged prostate symptoms. Scores ranging from 0-7 are considered to be mild symptoms, 8-19 are moderate and 20 - 35 are severe symptoms.
Time frame: Baseline, 1month, 6months, 12 months, 18 months and 24 months.
Change in Number of Subjects with Adverse events
Adverse events will be collected from patients based on CTCAE version 5.0.
Time frame: Baseline, 1month, 6months, 12 months and 24 months.
The change in radiation doses received by the surrounding normal structures/PTV for each initial and adapted plan will be analyzed with a signed-rank Wilcoxon test (non-parametric test for paired comparisons).
PTV is the planning target volume
Time frame: Baseline, 1month
Compare the changes in the Microbiome during SBRT-SIB
Gut microbiome samples will be obtained for 16S RNA analyses
Time frame: Baseline
Compare the changes in the Microbiome during SBRT-SIB
Gut microbiome samples will be obtained for 16S RNA analyses
Time frame: approx. 3 weeks
Compare the changes in the Microbiome during SBRT-SIB
Gut microbiome samples will be obtained for 16S RNA analyses
Time frame: 12 months
Compare the immunological changes during SBRT-SIB
serum samples will be obtained for immune correlate analyses
Time frame: Baseline
Compare the immunological changes during SBRT-SIB
serum samples will be obtained for immune correlate analyses
Time frame: approx. 3 weeks
Compare the immunological changes during SBRT-SIB
serum samples will be obtained for immune correlate analyses
Time frame: 12 months