MR Image Guided Therapy in Prostate Cancer
MR Image Guided Therapy in Prostate Cancer
Background:

 - One way to treat prostate cancer is to use a laser to direct extreme heat to a small area
 of the prostate. The heat destroys tumor cells but does not affect healthy tissue. Doctors
 want to see if magnetic resonance imaging (MRI) can be used to improve this treatment. MRI
 will be used to help locate tumor cells and guide the laser during surgery. However,
 MRI-guided laser therapy has not been used to treat many people with prostate cancer. More
 studies are needed to see whether it can destroy tumor cells permanently.

 Objectives:

 - To test the safety and effectiveness of treating prostate tumors with laser therapy guided
 by magnetic resonance imaging.

 Eligibility:

 - Men at least 18 years of age who have prostate cancer that can be seen with an MRI and has
 not spread to other parts of the body.

 Design:

 -  Participants will be screened with a physical exam and medical history. They will also
 have blood tests and imaging studies, and will complete questionnaires about their
 health.

 -  Participants will have the MRI-guided laser treatment in the hospital. The doctor will
 use the MRI to control how much energy is delivered by the laser and how much tissue is
 destroyed. The entire procedure usually takes from 1.5 to 3 hours.

 -  After the treatment, participants will have a catheter put in to keep the bladder
 emptied. The catheter will stay in for 1 to 7 days. Drugs to prevent infection and
 bladder spasms will be given. Participants will leave the hospital once they are well
 enough to go home.

 -  Participants will have followup visits 3, 6, 9, 12, 18, 24, and 36 months after the
 therapy. They will have physical exams, and blood and urine tests. They will also answer
 questionnaires. Participants will have MRI scans 6, 12, 24, and 36 months after the
 therapy. They will have a prostate biopsy to see if there is any tumor every 12 months
 for the first 2 years. Another biopsy may be done in the third year.
Background:

 -  Pilot study is designed to evaluate the safety and feasibility of thermal laser ablation
 of focal prostate tumors.

 -  Prostate cancer is relatively slow growing, with doubling times for local tumors
 estimated at 2 to 4 years.

 -  Some prostate cancers prove to be small, low grade, and noninvasive and they appear to
 pose little risk to the life or health of the host. Recent patient series suggest that
 20% to 30% of men undergoing radical prostatectomy have pathologic features in the
 radical prostatectomy specimen consistent with an insignificant or indolent cancer which
 poses little threat to life or health.

 -  We propose that patients with low volume and low grade disease can be best served with
 focal ablation of the visible prostate cancer without the side effects of urinary
 incontinence and erectile dysfunction associated with radiation therapy or radical
 surgery.

 Objectives:

 Primary Objective:

 -To determine feasibility and safety of magnetic resonance image-guided focal laser ablation
 of biopsy confirmed and MR visible prostate cancer.

 Eligibility:

 -  Greater than 18 years of age

 -  Organ confined prostate cancer, observed on MR, and confirmed by Transrectal biopsy

 -  Preoperative workup as dictated by the NCCN.org prostate cancer guidelines

 -  PSA < 15 ng or PSA density < 0.15 ng/ml in patients with a PSA > 15 ng

 Design:

 -  Pilot study, testing feasibility, safety and tolerability of thermal ablation of focal
 prostate cancer

 -  It is anticipated that 15 patients will be accrued for this study
-  INCLUSION CRITERIA:

 -  Men greater than 18 years of age

 -  Organ confined clinical T1C or clinical T2a prostate cancer that is visualized on MR
 imaging

 -  Prostate cancer is diagnosed by transrectal ultrasound guided standard 12 core biopsy
 or MR image guided biopsies

 -  Gleason Score less than or equal to 7 (3+4), less than or equal to 3 cores
 positive in a standard 12 core biopsy or less than or equal to 4 cores positive
 on MR image guided biopsy where in 2 cores are taken from each of the two MRI
 target lesions

 -  If the standard biopsy cores are positive, they must be from the same location in
 the prostate as MR Lesion was biopsied and proven to be cancer. (Left / Right,
 Base, Mid Gland, Apex).

 -  MRI obtained within 6 months of ablation

 -  Metastatic Disease work up as per NCCN guidelines (www.nccn.org) Bone scan indicated
 to r/o metastatic disease if [clinical T1 and PSA > 20 or T2 and PSA > 10]

 -  PSA less than or equal to 15 ng/ml or PSA density less than or equal to 0.15 ng/ml(2)
 in patients with a PSA > 15 ng/ml

 -  The patient has given written informed consent after the nature of the study and
 alternative treatment options have been explained.

 -  Patients who present with local recurrence or residual tumor after prostate cancer
 treatment which is visible on MRI.

 EXCLUSION CRITERIA:

 -  The presence of 3 or more MR Visible lesions positive on biopsy

 -  The presence of extra capsular, seminal vesical invasion or metastatic disease.

 -  Patient is unable to tolerate MRI (foreign body, i.e. pacemaker or other implanted
 device; claustrophobia; inability to tolerate rectal coil; etc )

 -  Patient with inability to follow up

 -  Acute urinary tract infection

 -  Lower urinary tract symptoms defined by a International Prostate symptom score (IPSS)
 >20

 -  Patients with renal insufficiency with an estimated glomerular filtration (EGF) <= 30
 are excluded, due to they will not be able to undergo gadolinium enhance MRI.

 -  Patients with Uncontrolled Coagulopathies who are at increased risk of bleeding.

 -  Altered mental status preventing consent or answering questions during conduct of the
 trial will be excluded for safety purposes.

 -  Other serious illnesses according to the PI: involving the cardiac, respiratory, CNS,
 renal or hepatic organ systems, which would preclude study completion or impede the
 determination of causality of any complications experienced during the conduct of this
 study.

 -  A Standard 12 core biopsy positive for cancer with no corresponding MR targeted lesion
 positive for cancer in the same general region of the prostate (Right Apex, Right Mid
 Gland, Right Base, Left Base, Left Mid Gland, Left Apex)