To Establish the Safety and Effectiveness of the ALPFA GRAIL PFA System for Treating Symptomatic Benign Prostate Hyperplasia (BPH) Also Known as an Enlarged Prostate. (REBOUND)

A Prospective Randomized Pivotal Trial of the ALPFA Medical Prostate Ablation System Compared With Cystoscopy in Men With Symptomatic Benign Prostatic Hyperplasia

The main goal of this study is to evaluate the ALPFA GRAIL™ Pulsed Field Ablation (PFA) System for treatment of enlarged prostate (BPH) symptoms. The study will involve up to 250 male participants who have urinary problems caused by BPH and whom are greater than 40 years of age in up to 30 investigational centers across the US,Canada and European Union.

Study Overview

• Status: Not yet recruiting
• Conditions: Benign Prostatic Hyperplasia (BPH)
• Intervention / Treatment: Device: Treatment Device: The ALPFA Medical (ALPFA) GRAIL™ Pulsed Field Ablation (PFA) System; Device: Control Device: Sham flexible cystoscopy

Detailed Description

This study aims to test how safe and effective the ALPFA BPH PFA System is for treating men over age 40 who have urinary problems caused by an enlarged prostate (BPH).The study will involve up to 250 participants in up to 30 investigational centers across the US, Canada, and European Union.

Men who agree to join the study will have health checks before treatment. Those who meet the study eligibility criteria including medication washout requirements,will be placed by chance into one of two groups. Two out of three men will receive treatment with the ALPFA BPH PFA System. One out of three men will receive a sham procedure that looks like treatment but does not deliver treatment.Participants will be followed for longer term safety and effectiveness for a total of 5 years post treatment with the ALPFA GRAIL™ Pulsed Field Ablation (PFA) System.

Patients and site personnel administering follow-up assessments will be blinded to the randomized treatment through completion of the 3-month follow-up visit.

After 3 months, participants will be told which group they were in. Men who were in the sham group may choose to receive treatment with the ALPFA BPH PFA System. Men in the sham group who do not choose treatment by 6 months will no longer take part in the study.

All men who receive treatment will have follow-up visits at 2 weeks, 4 weeks, 3 months, 6 months, and 12 months. After that, they will be checked once a year for up to 5 years.

• Study Type: Interventional
• Enrollment (Estimated): 250
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anitha Achyutha; Phone Number: +1. 858.349.9550; Email: aachyutha@alpfamedical.com
• Study Contact Backup: Name: Jaya Kothule; Phone Number: +1 408.480.2859; Email: jkothule@alpfamedical.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria: Study subjects are required to meet all the following inclusion criteria to participate in this study as determined by the Investigator:

1. ≥ 45 years of age on the day of enrollment.

2. Symptomatic BPH meeting all of the following criteria determined within 30 days preceding enrollment and after fulfilling the concomitant medication washout period(s):

   1. Symptom Score: Baseline IPSS score ≥13
   2. Flow Rate: Single uroflow test with a minimum voided volume ≥ 125 mL and a Qmax ≥ 5 mL/sec and ≤ 12 mL/s
   3. Residual: ultrasound-determined PVR of ≤ 250 mL
3. Prostate size 25-150 g, measured by transrectal ultrasound.
4. Willing and able to provide consent and comply with study requirements.

Exclusion Criteria:Subjects will be excluded from the study if they meet any one of the following exclusion criteria, as determined by the Investigator:

1. Medical conditions that would prevent participation in the study, interfere with assessment or therapy, significantly raise the risk of study participation, or confound data or its interpretation, including but not limited to:

   1. Cardiovascular:

      • History of clinically significant heart failure (NYHA III/IV)
      • Uncontrolled arrhythmia.
      • Stroke, TIA, myocardial infarction, unstable angina, percutaneous coronary intervention, or any cardiac surgery within 180 days of enrollment.
      • Uncontrolled hypertension
   2. Renal: Serum creatinine > 2.0 mg/dL or any history of renal dialysis or renal transplant.
   3. Metabolic: Clinically uncontrolled diabetes mellitus or a baseline HbA1c ≥ 8.0%, or clinically significant liver disease.
   4. Non-urologic cancer: Active malignancy, or within 3 years of enrollment, a history of treated malignancy now in full remission, except basal cell or squamous cell carcinoma of the skin.
   5. Respiratory: Severe lung disease or respiratory illness requiring hospitalization.
   6. Immunosuppression: Known immunosuppression, including but not limited to AIDS, immunosuppressive medication, or current chemotherapy.
   7. Transplant: Solid organ or hematologic transplant or currently being evaluated for an organ transplant.
   8. Substance abuse: Active alcoholism or drug addiction.

2. Urologic conditions that would prevent participation in the study, interfere with assessment or therapy, significantly raise the risk of study participation, or confound data or its interpretation, including but not limited to:

   1. Operative: Previous prostate surgery or interventional procedure, including but not limited to BPH surgery, radiation, laser, prostate arterial embolism, balloon dilatation, or hyperthermic treatment, or prostate biopsy within 40 days of the Index Procedure.
   2. Infection: Active urinary tract infection at the time of the Index Procedure (may be treated and enrolled upon negative urine culture).
   3. Incontinence: History of urinary incontinence.
   4. Retention: Requires indwelling catheter or intermittent catheterization to void or had an episode of spontaneous urinary retention within 30 days of enrollment.
   5. Prostatitis: History of prostatitis within 2 years of enrollment.
   6. Cystolithiasis: Active bladder stones
   7. Neurogenic bladder: Neurogenic or atonic bladder or sphincter, including etiologies of uncontrolled diabetes, Parkinson's disease, multiple sclerosis, cerebrovascular accident, or polyneuropathy.
   8. Anatomic abnormality: Prior or current urethral stricture, meatal stenosis, bladder neck contracture, or other urologic anatomic abnormalities that would interfere with planned treatment or confound subsequent assessment.
   9. Implants: Any urinary tract implants including stents, sutures, penile implants, or artificial sphincters.
   10. Hematuria: Hematuria without a known contributing factor within 90 days of the Index Procedure.
3. Bladder cancer: Actively being treated or suspected cancer of the bladder.
4. Baseline PSA > 10 ng/mL or confirmed or suspected prostate cancer (Subjects with a PSA level above 2.5 ng/mL, or age specific, or local reference ranges should have prostate cancer excluded to the Investigator's satisfaction following the site's standard of care.

5. Prior pelvic or rectal interventions:

   1. Previous pelvic irradiation or radical pelvic surgery
   2. Previous rectal surgery (other than hemorrhoidectomy) or a history of rectal disease that may be impacted by Index Procedure.
6. Peri-procedural anticoagulation: Unable to stop anti-platelet or anticoagulation treatment for the Index Procedure per site standard of care.

7. Subjects who cannot or will not comply with the following washout medication requirements within the time period specified prior to enrollment:

   1. 24-Hours:

      • i. Taking phenylephrine or pseudoephedrine within 24 hours of the Baseline evaluation and Index Procedure.

   2. 1 Week:

      • i. Antihistamine, anticonvulsant, or antispasmodics medications within 1 week of enrollment unless documented on a stable (unchanged) for 180 days prior to enrollment.

   3. 2 Weeks:

      • i. Use of alpha blockers or daily dosage of PDE5 inhibitors (tadalafil [Cialis]) for BPH within 2 weeks prior to enrollment.
      • ii. Use of anticholinergics or beta-3 adrenergic receptor agonists (e.g., mirabegron, vibegron) within 2 weeks prior to enrollment, unless documented on a stable dose for 30 days prior to enrollment.

   4. 3 Months:

      • i. Taking estrogen, drugs producing androgen suppression, or androgens within 90 days prior to enrollment, unless documented on a stable dosage for at least 90 days prior to enrollment.
      • ii. Use of Type II 5-alpha reductase inhibitor medication (e.g., finasteride [Proscar, Propecia]) within 90 days of enrollment OR anticipated use within the first 12 months of follow-up.

   5. 6 Months:

      • i. Use of any Type I 5-alpha reductase inhibitor medication (e.g., dutasteride [Avodart]) within 180 days prior to enrollment OR anticipate use within the first 12 months of follow-up.
      • ii. Taking tricyclic antidepressants that are not on a stable dose for the 180 days prior to enrollment OR anticipate stopping or changing treatment in the first 12 months of follow-up.
8. Subjects who wish to maintain their fertility.
9. Current or anticipated enrollment in any other randomized or interventional clinical study (registry or retrospective studies permitted).
10. Vulnerable populations, including individuals who are incarcerated or institutionalized.Any physical, psychological, or developmental impairment (e.g., developmental delay) that, in the investigator's opinion, would compromise the subject's ability to provide informed consent, comply with study procedures, or complete patient-reported outcome measures.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Treatment Device; Men who join the study will first have a health check to see if they can take part. If they meet the study requirements and have stopped any restricted medications, they will be assigned by chance to a treatment group and treated with the ALPFA GRAIL™ Pulsed Field Ablation (PFA) System(Treatment) per their randomized assignment. Participants will then have follow-up visits with health checks as planned for this study	Device: Treatment Device: The ALPFA Medical (ALPFA) GRAIL™ Pulsed Field Ablation (PFA) System; After the participant receives anesthesia, the Investigator will proceed with placement of the ALPFA GRAIL PFA Catheter into the prostate via a standard flexible cystoscope. Visualization of the prostatic urethra will determine the number of balloons that are exposed and inflated. When the catheter has been properly positioned, the ALPFA GRAIL PFA Console will be activated and one PFA application will be delivered. The Investigator will assess if the catheter needs to be repositioned and additional ablation applications delivered, as necessary. Once ablation is complete, the catheter balloons will be deflated, and the catheter will be withdrawn from the urethra. Participants will then have follow-up visits with health checks as planned for this study.
Sham Comparator: Control Device; Men who join the study will first have a health check to see if they can take part. If they meet the study requirements and have stopped any restricted medications, they will be assigned by chance to a control group and treated with sham flexible cystoscopy (Control) per their randomized assignment. Participants will then have follow-up visits with health checks as planned for this study	Device: Control Device: Sham flexible cystoscopy; Participants will receive mock treatment with a flexible cystoscope with a working channel that is at least 6.9F in diameter. The cystoscope will be inserted and treatment script initiated. Once the script is completed, the cystoscope will be removed and procedural details captured on the relevant CRF. Participants will then have follow-up visits with health checks as planned for this study.
Other: Crossover Cohort; Control Arm (Sham) patients can receive treatment with the ALPFA GRAIL™ Pulsed Field Ablation (PFA) System after their 3-month follow-up assessments are completed, and participant symptom profile necessaites treatment and alll protocol defined enrollment criteria are met. The study visit follow-up schedule will restart and the subject will be followed for 60 months post ALPFA GRAIL™ Pulsed Field Ablation (PFA) System(Treatment)Unless treated with the ALPFA GRAIL™ Pulsed Field Ablation(PFA)System, the subject will be exited from the study once they have completed their 3-month follow-up visit.	Device: Treatment Device: The ALPFA Medical (ALPFA) GRAIL™ Pulsed Field Ablation (PFA) System; After the participant receives anesthesia, the Investigator will proceed with placement of the ALPFA GRAIL PFA Catheter into the prostate via a standard flexible cystoscope. Visualization of the prostatic urethra will determine the number of balloons that are exposed and inflated. When the catheter has been properly positioned, the ALPFA GRAIL PFA Console will be activated and one PFA application will be delivered. The Investigator will assess if the catheter needs to be repositioned and additional ablation applications delivered, as necessary. Once ablation is complete, the catheter balloons will be deflated, and the catheter will be withdrawn from the urethra. Participants will then have follow-up visits with health checks as planned for this study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety-Incidence of Serious Device-or Procedure-Related Adverse Events (Composite Safety Endpoint)	The primary safety endpoint is the proportion of participants experiencing one or more of the following serious device-related or procedure-related adverse events: Internal Tears: Any accidental holes or tears in the rectum, bladder, or digestive tract. Abnormal Connections (Fistula): The development of an unintended opening or passage between the rectum and the tube that carries urine (urethra). Inability to Urinate: A new, ongoing problem where a participant cannot empty their bladder and requires a tube (catheter) for more than 28 days after the procedure. Leaking Urine: New or persistent "stress incontinence," which is the accidental leaking of urine during physical activity, coughing, or sneezing. Severe Bleeding: Any bleeding serious enough to require a blood transfusion or a follow-up surgery to stop it. Injury to the urinary tube (urethra) or the lining of the prostate (capsule) that is severe enough to require surgery.	Through 90 days post-procedure
Effectiveness-Change from Baseline in International Prostate Symptom Score (IPSS) at 3 Months.	The International Prostate Symptom Score (IPSS) is a 7-item questionnaire (score range 0-35) where higher scores indicate more severe symptoms. Success is defined as the Treatment group showing a 25% greater relative improvement in mean score compared to the Control group	Baseline to 3 months post-procedure
Effectiveness-Durability of Treatment Effect: Percent Change in International Prostate Symptom Score (IPSS) at 12 Months	This endpoint evaluates the long-term effectiveness of the ALPFA GRAIL PFA System. It is calculated as the mean percentage change in the total International Prostate Symptom Score (IPSS) score from the start of the study (baseline) to the 12-month follow-up for participants in the treatment group.	Baseline to 12 months post-procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Additional Study Goals	1.Comparison of Symptom Improvement (at 3 Months) Researchers will compare the average change in prostate symptoms between the group that received the study treatment and the control group. This helps show if the treatment provides more relief than the standard comparison.	3 months
Success Stories (Responder Rate)	2. Number of "Success Stories" (Responder Rate) The study will count how many participants had a meaningful improvement in their symptoms. A "responder" (a success) is defined as a person whose symptoms improved by at least 30% three months after the treatment.	3 months
Improvement in Urine Flow	3. Improvement in Urine Flow (Qmax) Researchers will measure the strength of the participant's urine flow. They will compare the average change in flow strength from the start of the study to three months later between the treatment group and the control group.	3 months

Collaborators and Investigators

• Sponsor: ALPFA Medical
• Investigators: Principal Investigator: Dr. Bilal Chughtai, The Smith Institute of Urology/Northwell Health; Principal Investigator: Dr. Dean Elterman, University Health Network, Toronto

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): August 1, 2028
• Study Completion (Estimated): December 1, 2032

Study Registration Dates

• First Submitted: April 27, 2026
• First Submitted That Met QC Criteria: May 11, 2026
• First Posted (Actual): May 18, 2026

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: enlarged prostate
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Genital Diseases, Male; Prostatic Diseases; Male Urogenital Diseases; Prostatic Hyperplasia; Therapeutics; Drug Therapy; Drug Delivery Systems
• Other Study ID Numbers: CS00004

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes