A Comparison of TULSA Procedure vs. Radical Prostatectomy in Participants With Localized Prostate Cancer

Clinicaltrials.gov ID: NCT05027477
db-list-check Status RECRUITING
b-loader Phase NA
b-people Age 40 - 80 Years
b-bullseye-arrow Enrollments 201

Conditions

Prostate Cancer, Prostate Adenocarcinoma

Summary

Men with localized, intermediate risk prostate cancer will be randomized to undergo either radical prostatectomy or the TULSA procedure, with a follow-up of 10 years in this multi-centered randomized control trial. This study will determine whether the TULSA procedure is as effective and more safe compared to radical prostatectomy.

Detailed Description

The typical standard of care for patients with localized, intermediate risk prostate cancer is radical prostatectomy, which involves the surgical removal of the prostate. Although radical prostatectomy is effective in terms of controlling the cancer, it may leave men with significant long-term effects in urinary, sexual function like erectile dysfunction and/or incontinence (loss of bladder control), thus reducing quality of life. Preservation of continence (ability to control your bladder) and potency (ability to achieve erection and/or ejaculation) may be significant concerns for men.

Targeted ablation of localized prostate cancer using MRI-guided technology is becoming a favorable option for many men who wish to have their cancer treated but do not wish to compromise their urinary and sexual functions. The TULSA Procedure is a new, minimally-invasive technique that uses real-time MRI-guided technology to guide the delivery of high-energy ultrasound to precisely, and in a customized fashion specific to you, heat and kill the prostate cancer tissue while protecting important surrounding body parts that are important for preserving urinary and sexual function. Minimally invasive here means that the procedure is performed through natural openings in your body (the urethra) instead of creating larger openings like traditional surgery or minimally invasive surgery.

The purpose of this research study is to:

* Test whether the TULSA Study Procedure preserves or improves your quality of life (urinary, bowel and sexual functions) at 12 months post-study treatment compared to standard of care (radical prostatectomy).
* Test how many subjects who undergo the TULSA Study Procedure are free from treatment failure by 3 years post-study treatment compared to subjects who undergo the standard of care (radical prostatectomy). Treatment failure is defined as undergoing other additional prostate cancer treatments, spreading of cancer or death caused by cancer.

About 201 subjects will participate in this study with 67 randomly assigned to the radical prostatectomy group and 134 randomly assigned to the TULSA procedure group. Patients will have a 1 in 3 chance of being assigned to the radical prostatectomy group and a 2 in 3 chance of being assigned to the TULSA group. Following treatment, patients will be followed up for 10 years.

Locations

16 locations Found with status Recruiting

Status

  • RECRUITING

Contact Person

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  • RECRUITING

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  • Marchelle Mehan
  • 480-219-1010

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  • RECRUITING

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  • RECRUITING

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  • RECRUITING

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  • Carlos Lopez
  • 213-212-4313

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  • RECRUITING

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  • RECRUITING

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  • RECRUITING

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  • Ali-Reza Sharif-Afshar

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  • RECRUITING

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  • RECRUITING

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  • RECRUITING

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Eligibility Criteria

Inclusion Criteria:

* Male
* Age 40 to 80 years, with >10 years life expectancy
* NCCN (favorable and unfavourable) intermediate-risk prostate cancer on biopsy acquired within last 12 months
* Stage ≤cT2c, N0, M0
* ISUP Grade Group 2 or 3 disease on TRUS-guided biopsy or in-bore biopsy
* PSA ≤20ng/mL within last 3 months
* Treatment-naïve
* Planned ablation volume is < 3 cm axial radius from urethra on mpMRI acquired within last 6 months

Exclusion Criteria:

* Inability to undergo MRI or general anesthesia
* Suspected tumor is > 30 mm from the prostatic urethra
* Prostate calcifications > 3 mm in maximum extent obstructing ablation of tumor
* Unresolved urinary tract infection or prostatitis
* History of proctitis, bladder stones, hematuria, history of acute urinary retention, severe neurogenic bladder
* Artificial urinary sphincter, penile implant, or intraprostatic implant
* Patients who are otherwise not deemed candidates for radical prostatectomy
* Inability or unwillingness to provide informed consent
* History of anal or rectal fibrosis or stenosis, or urethral stenosis, or other abnormality challenging insertion of devices

Study Plan

Radical Prostatectomy

ACTIVE_COMPARATOR

Patients in this group will undergo Radical prostatectomy. There will be about 67 people in this group.

  • DEVICE:

    Radical Prostatectomy

    Description:

    If you are in this group, you will get the standard of care treatment used to treat this type of cancer: radical prostatectomy. You will undergo this procedure as per standard clinical practice. A radical prostatectomy is a surgical procedure that removes the prostate gland. This is done by making a surgical incision and removing the prostate gland.

TULSA Procedure

EXPERIMENTAL

Patients in this group will undergo TULSA Procedure. There will be about 134 people in this group.

  • DEVICE:

    TULSA Procedure

    Description:

    If you are in this group, you will get the TULSA Procedure. The TULSA Procedure is a minimally invasive procedure that uses directional ultrasound to produce very high temperature to ablate (destroy) targeted prostate tissue. The procedure is performed in a MRI suite (the physician can see the prostate at all times throughout the procedure) and uses the TULSA-PRO system to ablate prostate tissue. The procedure combines real-time MRI with robotically-driven directional thermal ultrasound to deliver predictable, physician-prescribed ablation of the prostate. Minimally invasive here means that the procedure is performed through natural openings in your body (the urethra) instead of creating larger openings like in traditional surgery.

Outcome Measures

Primary Outcome Measures

Safety endpoint - proportion of patients who maintain both urinary continence and erectile potency

Time Frame: 12 months post-treatment

Efficacy endpoint - proportion of patients free from treatment failure

Time Frame: 36 months post-treatment

Secondary Outcome Measures

Biochemical failure endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

Histological failure endpoint

Time Frame: At 12 month post treatment, and also at 24 months post treatment for patients who undergo a repeat TULSA

mpMRI endpoint (for Tulsa arm only)

Time Frame: At 12 month post treatment, and also at 24 months post treatment for patients who undergo a repeat TULSA

Salvage-free survival endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

Metastases-free survival endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

Prostate cancer-specific survival endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

Overall survival endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

Surgical complications endpoint

Time Frame: At the following study visits post treatment: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5 years

Penile rehabilitation endpoint

Time Frame: At the following study visits post treatment: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5 years

Penile length endpoint

Time Frame: At 1 month and 12 months post-treatment

Blood loss endpoint

Time Frame: During the procedure and immediately after the procedure

Transfusion volume endpoint

Time Frame: During the procedure and immediately after the procedure

Inpatient hospital stay endpoint

Time Frame: Immediately after the procedure

IIEF-15 Endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

IPSS Endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

EPIC Endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years

NRS Endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24, and 36 months.

EQ-5D-5L Endpoint

Time Frame: At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24, and 36 months.

Timeline

  • Last Updated
    November 12, 2024
  • Start Date
    August 30, 2021
  • Today
    February 5, 2025
  • Completion Date ( Estimated )
    December 9, 2034

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