A Comparison of TULSA Procedure vs. Radical Prostatectomy in Participants With Localized Prostate Cancer
Conditions
Prostate Cancer, Prostate AdenocarcinomaSummary
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
- Marchelle Mehan
- 480-219-1010
Status
- RECRUITING
Contact Person
- Carlos Lopez
- 213-212-4313
Status
- RECRUITING
Contact Person
- Ali-Reza Sharif-Afshar
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 ProstatectomyDescription:
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 ProcedureDescription:
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
Efficacy endpoint - proportion of patients free from treatment failure
Secondary Outcome Measures
Biochemical failure endpoint
Histological failure endpoint
mpMRI endpoint (for Tulsa arm only)
Salvage-free survival endpoint
Metastases-free survival endpoint
Prostate cancer-specific survival endpoint
Overall survival endpoint
Surgical complications endpoint
Penile rehabilitation endpoint
Penile length endpoint
Blood loss endpoint
Transfusion volume endpoint
Inpatient hospital stay endpoint
IIEF-15 Endpoint
IPSS Endpoint
EPIC Endpoint
NRS Endpoint
EQ-5D-5L Endpoint
Timeline
Last Updated
November 12, 2024Start Date
August 30, 2021Today
January 16, 2025Completion Date ( Estimated )
December 9, 2034
Sponsors of this trial
Lead Sponsor
Profound Medical Inc.