This clinical trial tests the effect of focal radiation therapy, high dose rate-brachytherapy (HDR-BT), in treating patients with prostate cancer. Prostate cancer is the most diagnosed cancer in men and there are many treatments available, including surgery and radiation therapy. Although surgery and radiation therapy improve survival urinary and sexual function can be significantly affected and can be long lasting. HDR-BT, a type of focal radiation therapy also known as internal radiation therapy, uses radioactive material placed directly into or near a tumor to kill tumor cells. Giving HDR-BT may be effective in providing local control while reducing side effects in patients with prostate cancer.
PRIMARY OBJECTIVES: I. Estimate local control. II. Estimate acute/late grade 2+ genitourinary (GU)/gastrointestinal (GI) toxicity. SECONDARY OBJECTIVES: I. Prostate specific antigen (PSA) response at 6 weeks after radiation therapy (RT), every 3 months for 24 months, every 6 months to 60 months, then every 8-12 months until 5 years. II. Clinical progression free survival/biochemical progression free survival at 5 years. III. Distant metastasis free survival. IV. Development of castration-resistant disease. V. Overall survival. VI. Changes in quality of life VIa. Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire; VIb. Expanded Prostate Cancer Index Composite Short Form (EPIC-26) questionnaire. OUTLINE: Patients undergo HDR-BT to dominant prostate lesion on day 1. Treatment repeats at least 3 weeks apart for up to 2 fractions in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection, multiparametric (mp) magnetic resonance imaging (MRI) and optionally prostate-specific membrane antigen (PSMA) positron emission tomography (PET) throughout the study. Additionally, patients may undergo tumor biopsy as clinically indicated throughout the study. After completion of study treatment, patients are followed up at 6 weeks, every 3 months for the first 2 years, every 6 months for years 3 and 4, then annually thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Undergo tumor biopsy
Undergo blood sample collection
Undergo HDR-BT
Undergo mpMRI
Undergo PSMA PET
Ancillary studies
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, United States
Incidence of grade 2 or greater genitourinary adverse events (AEs)
Will be defined as the percentage of patients who encounter the AE of specific grade or worse using Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0. Will be calculated to indicate the toxicity level of focal radiation therapy (RT), along with the corresponding 95% Clopper-Pearson exact confidence interval.
Time frame: Up to 6 years
Incidence of grade 2 or greater gastrointestinal AEs
Will be defined as the percentage of patients who encounter the AE of specific grade or worse using CTCAE v 5.0. Will be calculated to indicate the toxicity level of focal RT, along with the corresponding 95% Clopper-Pearson exact confidence interval.
Time frame: Up to 6 years
Time to first grade 2 or greater adverse event
Will be analyzed as a time-to-event outcome using Kaplan-Meier (KM) methods.
Time frame: Up to 6 years
Local control rate
Will be defined as lack of biopsy proven progression within target/treated region/lesion. The proportion of patients achieving local control will be estimated along with the corresponding 95% Clopper-Pearson exact confidence interval.
Time frame: Up to 6 years
Prostate specific antigen (PSA) response
PSA changes over time will be assessed via repeated measures analysis of variance (ANOVA). If significant PSA changes over time are identified by repeated measures ANOVA, the individual comparisons between time points will be evaluated via Tukey's Honestly Significant Difference test as the method of accommodating multiple comparisons.
Time frame: At 3, 6, 12 and 24 months
Biochemical progression free survival
Will be obtained via KM analysis to provide an overview of efficacy for focal RT.
Time frame: Up to 5 years
Clinical progression free survival
Will be obtained via KM analysis to provide an overview of efficacy for focal RT.
Time frame: Up to 5 years
Distant metastasis free survival
Will be obtained via KM analysis to provide an overview of efficacy for focal RT.
Time frame: Up to 5 years
Overall survival
Will be obtained via KM analysis to provide an overview of efficacy for focal RT.
Time frame: Up to 6 years
Patient reported quality of life
Will be evaluated using Functional Assessment of Cancer Therapy-Prostate questionnaire (FACT-P). The FACT-P uses a 5-point Likert scale for scoring, with total scores ranging from 0 to 156. Higher scores indicate better quality of life. The change of the scores between the time of pre-focal RT and post-focal RT will be assessed via two-sided paired t-test.
Time frame: Up to 6 years
Expanded Prostate Cancer Index Composite Short Form questionnaire score
The change of the scores between the time of pre-focal RT and post-focal RT will be assessed via two-sided paired t-test.
Time frame: Up to 6 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.