- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01194648
Focal Therapy for Prostate Cancer Using HIFU (INDEX)
A Multi-Center Prospective Single Arm Intervention Trial Evaluating Focal Therapy Using High Intensity Focused Ultrasound (Sonablate 500) for Localized Prostate Cancer
Study Overview
Status
Intervention / Treatment
- Other: questionnaire administration
- Procedure: quality-of-life assessment
- Procedure: multiparametric magnetic resonance imaging
- Procedure: transperineal prostate biopsy
- Procedure: transrectal prostate biopsy
- Procedure: assessment of therapy complications
- Procedure: high-intensity focused ultrasound ablation
Detailed Description
Verification of a new therapy as favourable, or equivalent, in outcome to 'standard' care is ideally sought through comparison with another matched control group. Randomised controlled trials (RCTs) offer the best method for minimising systematic bias and revealing the true effect of an intervention or drug. However, RCTs involving treatments of localised prostate cancer have had a historically poor patient uptake, as the reference 'gold' standard of care is not known. In addition, RCTs are expensive to run and involve huge infra-structural support. A number of trials in the USA have been forced to close due to lack of recruitment. The ProStart trial in the UK has also had to close for the same reason. It has been acknowledged by the Food and Drug Agency in the USA that comparative randomized trials will be problematic in this area due to lack of physician and patient equipoise. A randomized trial may be feasible if a pragmatic design is adopted but prior to acceptance of such a design, the number of centres with expertise in this complex intervention (mp-MRI, TTPM, focal HIFU) will need to be increased.
Observational studies are a commonly used alternative to ascertain the effectiveness of a treatment. They are used to observe a treatment effect in a selected group of patients who are presumed to derive benefit from the treatment given. Although methodologically not as robust, and therefore prone to bias, they have some benefits over RCTs. The principal ones are those of enhanced external validity (many patients do not wished to be randomised and therefore refuse participation), and more rapid accrual compared to a randomised design. For this reasons, a single arm medium term follow-up cohort intervention study has been designed. At the time of writing the safety and tolerability aspects of focal therapy by HIFU are known as a result of the Phase I/II studies carried out at UCLH. The results have been presented and exist in the public domain in abstract form but have not yet been published (presented in tables above). These early studies were powered to detect a change in the proportion of men who could obtain an erection sufficient for penetration compared to their status prior to their treatment. The very low event rate for both erectile dysfunction and incontinence indicates that the 'proof of concept' has been demonstrated for focal therapy. Moreover, we can be relatively confident that, in expert hands, focal HIFU is safe. Therefore, a multi-centre study is now required involving a larger group of patients for the following reasons:
- To evaluate medium term cancer control using histological parameters. Stage two of INDEX will evaluate conversion to radical and systemic therapies and link men to national databases to determine survival in 5 and 10 years.
- To confirm that focal therapy can lead to low rates of genitourinary and rectal toxicity and minimal impact on quality of life within a large and more representative cohort of patients (greater precision around outcome measures).
- To demonstrate that the skills (characterization through template prostate mapping and MRI as well as the treatment related skills) acquired by the team at UCLH are indeed transferable to other providers.
- To calculate costs of care and to model potential cost-effectiveness in comparison to alternative therapies. If this single arm intervention study demonstrates acceptable outcomes to support the findings of the Phase I/II studies, it is anticipated that this preliminary study will lead onto a Phase III evaluation of focal therapy, prior to more widespread use of this technology.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
England
-
London, England, United Kingdom, WC1E 6BT
- Recruiting
- University College London
-
Contact:
- SITU Trials Unit
- Phone Number: +44207 679 9280
- Email: situ.index@ucl.ac.uk
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
- Histologically proven prostate cancer on trans-rectal or transperineal template prostate biopsies.
Prostate biopsy (either TRUS or MRI Targeted or Template):
- TRUS biopsy: up to burden bilateral disease with maximum 3mm one biopsy on non-dominant side is allowable.
- MRI targeted and/or Template biopsy within 12 months of entry showing:
- unilateral disease minimum 3mm of Gleason 3+3 or any Gleason 3+4 or 4+3 but not exceeding Gleason 4+3 overall OR
- bilateral disease presence of clinically significant cancer on only one side (as determined by histological rules described above) Gleason ≤7 which is concordant with the MRI findings.
- Stage T1-T2cN0M0 disease, as determined by local guidelines (radiological T3a permitted).
- Serum PSA </=20ng/ml
- Life expectancy of >/=10 years.
- Signed informed consent by patient.
- An understanding of the English language sufficient to understand
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: High Intensity Focused Ultrasound
HIFU, the Intervention
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Conversion to radical therapy and/or requiring systemic therapy and/or developing metastases and/or dying of prostate cancer
Time Frame: 5 years
|
To determine the proportion of men converting to radical therapy and/or requiring systemic therapy and/or developing metastases and/or dying of prostate cancer following focal therapy for localised prostate cancer using HIFU
|
5 years
|
Conversion to radical therapy and/or requiring systemic therapy and/or developing metastases and/or dying of prostate cancer
Time Frame: 10 years
|
To determine the proportion of men converting to radical therapy and/or requiring systemic therapy and/or developing metastases and/or dying of prostate cancer following focal therapy for localised prostate cancer using HIFU
|
10 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
rate of erectile dysfunction
Time Frame: 12 months
|
The presence of severe erectile dysfunction at 12 months, as measured by the IIEF-5 questionnaire with or without the use of phosphodiesterase-5 inhibitors, in those with absence of severe erectile dysfunction at baseline
|
12 months
|
rate of erectile dysfunction
Time Frame: 24 months
|
The presence of severe erectile dysfunction at 24 months, as measured by the IIEF-5 questionnaire with or without the use of phosphodiesterase-5 inhibitors, in those with absence of severe erectile dysfunction at baseline
|
24 months
|
time to return of erectile function
Time Frame: 24 months
|
Time to return of erectile function (absence of severe ED on IIEF-15 questionnaire)
|
24 months
|
rate of urinary incontinence (pad free, leak free and pad-free alone)
Time Frame: 12 months
|
Presence of urinary incontinence (any pad usage plus any leakage of urine) as determined by the UCLA-EPIC urinary continence questionnaire, at 12 months, in those men with no urinary incontinence at baseline
|
12 months
|
rate of urinary incontinence (pad free, leak free and pad-free alone)
Time Frame: 24 months
|
Presence of urinary incontinence (any pad usage plus any leakage of urine) as determined by the UCLA-EPIC urinary continence questionnaire, at 24 months, in those men with no urinary incontinence at baseline
|
24 months
|
time to return of continence (pad free, leak free and pad-free alone)
Time Frame: 24 months
|
Time to return of urinary continence (as determined by UCLA-EPIC Urinary domain questionnaire)
|
24 months
|
rate of loss of ejaculation
Time Frame: 24 months
|
rate of loss of ejaculation (as determined by IIEF-15 questionnaire)
|
24 months
|
rate of loss of orgasm
Time Frame: 24 months
|
rate of loss of orgasm (as determined by IIEF-15 questionnaire)
|
24 months
|
rate of pain during intercourse
Time Frame: 24 months
|
rate of pain during intercourse (as determined by IIEF-15 questionnaire)
|
24 months
|
number of men using phosphodiesterase-5 inhibitors to maintain erectile function
Time Frame: 24 months
|
Need for phosphodiesterase-5 inhibitors to maintain erectile function sufficient for penetration up to 24 months
|
24 months
|
rate of lower urinary tract symptoms
Time Frame: 24 months
|
Grading of lower urinary tract symptoms as determined by IPSS scores
|
24 months
|
rate of bowel toxicity
Time Frame: 24 months
|
UCLA-EPIC Bowel Function Questionnaire
|
24 months
|
anxiety levels
Time Frame: 24 months
|
EQ-5D Quality of Life Questionnaire
|
24 months
|
general health related quality of life
Time Frame: 24 months
|
General and prostate health related quality of life measured using EQ-5D Quality of Life questionnaire
|
24 months
|
proportion of men achieving trifecta status at 12 months
Time Frame: 12months
|
Achievement of trifecta status (no severe ED, pad-free leak-free continence, cancer control with absence of clinically significant cancer) at 12 months in those men with good baseline function
|
12months
|
proportion of men achieving trifecta status at 24 months
Time Frame: 24 months
|
Achievement of trifecta status (no severe ED, pad-free leak-free continence, cancer control with absence of clinically significant cancer) at 24 months in those men with good baseline function
|
24 months
|
rate of secondary prostate cancer intervention (prostatectomy, radiotherapy, androgen ablation, whole-gland HIFU or cryosurgery)
Time Frame: 24 months
|
rate of secondary prostate cancer intervention (prostatectomy, radiotherapy, androgen ablation, whole-gland HIFU or cryosurgery)
|
24 months
|
risk factors for failure defined as a) presence of any cancer and b) clinically significant cancer at study end
Time Frame: 24 months
|
risk factors for failure defined as a) presence of any cancer and b) clinically significant
|
24 months
|
biochemical (PSA) kinetics including determining the optimal biochemical definition of failure
Time Frame: 24 months
|
biochemical (PSA) kinetics including determining the optimal biochemical definition of
|
24 months
|
describe composite outcomes of failure
Time Frame: 24 months
|
describe composite outcomes of failure
|
24 months
|
Cost-effectiveness
Time Frame: 5years
|
To determine the costs of treatment and model potential cost effectiveness using comparative cancer control and functional outcomes at 5 years compared to other cohort trials involving the management of localized prostate cancer
|
5years
|
Cost-effectiveness
Time Frame: 10 years
|
To determine the costs of treatment and model potential cost effectiveness using comparative cancer control and functional outcomes at 10 years compared to other cohort trials involving the management of localized prostate cancer
|
10 years
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Mark Emberton, MD, FRCS, MBBS, University College, London
- Study Chair: Hashim Uddinn Ahmed, MD, FRCS, Imperial College London
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Mental Disorders
- Neoplasms
- Urogenital Neoplasms
- Neoplasms by Site
- Urologic Diseases
- Lower Urinary Tract Symptoms
- Urological Manifestations
- Genital Neoplasms, Male
- Prostatic Diseases
- Urination Disorders
- Sexual Dysfunctions, Psychological
- Sexual Dysfunction, Physiological
- Elimination Disorders
- Prostatic Neoplasms
- Urinary Incontinence
- Erectile Dysfunction
- Enuresis
Other Study ID Numbers
- CDR0000684020
- 9945 (Other Identifier: Ohio State University Medical Center)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Urinary Incontinence
-
University of New MexicoRecruitingUrinary Incontinence | Urge Incontinence | Stress Incontinence, FemaleUnited States
-
Juna d.o.o.CompletedFemale Stress Urinary Incontinence | Mixed Incontinence, Urge and Stress
-
University of California, San FranciscoNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Stanford...CompletedUrinary Incontinence, Stress | Urge Incontinence | Urinary Stress Incontinence | Stress Incontinence, Urinary | Stress Incontinence | Stress Incontinence, Female | Urgency UrinaryUnited States
-
Ludwig-Maximilians - University of MunichUnknownIncontinence, Overactive Bladder, Stress Urinary IncontinenceGermany
-
San Diego Sexual MedicineRecruitingStress Urinary Incontinence | Urge IncontinenceUnited States
-
Copenhagen University Hospital at HerlevZealand University HospitalTerminatedStress Urinary Incontinence | Urge Urinary IncontinenceDenmark
-
Far Eastern Memorial HospitalRecruitingWomen With Stress Urinary IncontinenceTaiwan
-
ScitonCompletedUrinary Incontinence | Stress Urinary Incontinence | Urge IncontinenceUnited States
-
Université de SherbrookeRecruitingUrinary Incontinence | Urinary Stress Incontinence | Post-Prostatectomy Incontinence | Stress Incontinence, MaleCanada
-
Hadassah Medical OrganizationCompletedUrinary Stress Incontinence (SI)Israel
Clinical Trials on questionnaire administration
-
Fondazione Don Carlo Gnocchi OnlusUnknown
-
Centre Oscar LambretCentre Hospitalier Universitaire de BesanconTerminated
-
Rutgers, The State University of New JerseyNational Cancer Institute (NCI)TerminatedHealth Status UnknownUnited States
-
Istanbul Aydın UniversityCompleted
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)Active, not recruitingBreast Carcinoma | Fallopian Tube Carcinoma | Endometrial Carcinoma | Ovarian Carcinoma | Primary Peritoneal Carcinoma | Deleterious CDH1 Gene Mutation | Deleterious DICER1 Gene Mutation | Deleterious SMARCA4 Gene Mutation | Deleterious STK11 Gene MutationUnited States
-
Université Catholique de LouvainRecruiting
-
M.D. Anderson Cancer CenterRecruitingHematopoietic and Lymphoid Cell Neoplasm | Malignant Solid NeoplasmUnited States
-
M.D. Anderson Cancer CenterRecruitingBreast CarcinomaUnited States
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)RecruitingCOVID-19 InfectionUnited States
-
Istituto Ortopedico RizzoliUniversity of BolognaCompletedArthroplasty, Replacement, Knee | Arthroplasty, Replacement, Hip | Arthroplasty, Replacement, ShoulderItaly