BETTY: BEnign Prostatic Hyperplasia Transperineal Targeted Microwave therapY
Study Details
Study Description
Brief Summary
This is a pilot study on applying 3D-Ultrasound-Guided Transperineal Microwave needle ablation for men with symptomatic benign prostatic hyperplasia (BPH).
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
This is a prospective, single centre, open-label and non-comparative trial planned on 12 patients. Patients who fit inclusion criteria would be recruited and offered microwave ablation to the enlarged prostate. The patients will be closely followed up to 6 months after treatment with serial assessment on safety and efficacy.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Transperineal Microwave needle ablation for symptomatic BPH
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Device: 3D-Ultrasound-Guided Transperineal Microwave needle ablation of BPH
The procedure will consist of a focal, transperineal, targeted microwave ablation of prostate adenoma. Surgical planning using 3D transrectal ultrasound and real-time monitoring of the ablation would preserve key anatomical landmarks such as the bladder neck, prostatic urethra and verumontanum. The Organ-Based Tracking (OBT®) patented technology would provide a 3D prostate model to facilitate real-time navigation-guided ablation and accurate mapping of treatment zone. The procedure will be conducted under general anaesthesia, spinal anaesthesia, or monitored anaesthetic care / sedation. An average number of one to three microwave ablations per lobe is expected, depending on the size and shape of each prostate. The microwave ablation parameters will be chosen intraoperatively. A urinary catheter may be necessary immediately after the procedure. Patients are planned to be discharged on the same day or the day after when they are fit for discharge.
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Outcome Measures
Primary Outcome Measures
- Adverse events (AE) and serious adverse events (SAE) related to the treatment [At 1 month]
The severity of AE is grade by Clavien-Dindo classification.
Secondary Outcome Measures
- Prostate volume change [Baseline, 3 months, 6 months]
Prostate volume change after treatment
- Urinary symptoms measured by International Prostate Symptom Score (IPSS) score [Baseline, 1 month, 3 months, 6 months]
Change in total scores in International Prostate Symptom Score (ranges from 0 to 35) questionnaires. The higher score, the more worse symptom.
- Erectile function measured by International Index of Erectile Function 5-item version (IIEF-5) score [Baseline, 1 month, 3 months, 6 months]
Change in International Index of Erectile Function 5 questionnaire score (ranges from 0 to 25). The higher score, the more worse symptom.
- Ejaculatory function measured by MSHQ-EjD-SF (function and bother) score [Baseline, 1 month, 3 months, 6 months]
Change in MSHQ-EjD-SF questionnaire score (Range from 1-15 for function and and 0-5 for bother). The higher score, the more worse symptom.
- Change in urodynamic in uroflowmetry [Baseline, 1 month, 3 months, 6 months]
Change in urodynamic function assessed by uroflowmetry, parameters include voided volume, maximum flow rate and post-void residual.
- PSA change [Baseline, 3 months, 6 months]
PSA change after treatment
- Average patient post-operative pain level [Baseline, 2 and 4 hours after the procedure and at 1-week]
Assessed by a pain numeric rating scale, Score 0-10, the higher score the worsen pain
- Patient quality of life [Baseline, 1-week, 1-month, 3-month, and 6-month,]
Assessed with the EQ-5D-5L questionnaire, the higher the score the better in quality of life
- Patient satisfaction [Baseline, 1-week, 1-month, 3-month, and 6-month,]
Assessed with the PGI-I questionnaire,the lower score the more satisfaction
- Ease of the procedure measured with a score chosen by the operator [Post procedure immediately]
1: easy, 2: moderate, 3: difficult
- Ablation treatment time [Intra-operation]
Duration of the ablation procedure
- Length of hospital stay [The total number of days of hospitalization for this surgical procedure up to day 30 after the procedure]]
Total number of days of hospitalization for the surgical procedure
- Operation time [Intra-operation]
Duration of patients stay in Operation Room
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age over 50 years.
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Benign prostatic hyperplasia with prostate size 30-80 cc
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IPSS ≥ 14
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PSA ≤ 4 ng/mL or PSA >4 ng/mL with no evidence of suspicious lesion on mpMRI
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Maximum urine flow rate (Qmax) ≤ 15 mL/s.
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Post-Void Residual ≤ 150 mL.
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Patient suitable for IV sedation and/or spinal anaesthesia and/or general anaesthesia and focal microwave ablation.
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Informed written consent
Exclusion Criteria:
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Significant intravesical median lobe hyperplasia.
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Suspicious lesion on mpMRI prostate
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History of prostate, bladder or urethral surgery.
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History of prostate cancer
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Presence of stones, bladder diverticulum and/or bladder tumor
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History of long-term indwelling catheter.
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Urethral stricture
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Known coagulopathy or on anticoagulant
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Presence of a pacemaker.
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Active infection
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Dysuria due to bladder dysfunction.
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Serious medical illness, including any of the following: uncontrolled congestive heart failure, uncontrolled angina, myocardial infarction, cerebrovascular event within 6 months prior to the screening visit.
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Neurological disorders that would impact bladder function (e.g., multiple sclerosis, Parkinson's disease, spinal cord injury).
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Contraindications for mpMRI exam or MR contrast
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Acute and/or chronic renal failure (GFR <50 ml/min and serum creatinine > 1.5 mg/d).
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Patient currently participating in another interventional clinical trial.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Prince of Wales Hospital | Hong Kong | Hong Kong |
Sponsors and Collaborators
- Chinese University of Hong Kong
- Koelis
Investigators
- Principal Investigator: Peter Ka-Fung CHIU, FRCS, PhD, Chinese University of Hong Kong
Study Documents (Full-Text)
None provided.More Information
Publications
- Barry Delongchamps N, Schull A, Anract J, Abecassis JP, Zerbib M, Sibony M, Jilet L, Abdoul H, Goffin V, Peyromaure M. Feasibility and safety of targeted focal microwave ablation of the index tumor in patients with low to intermediate risk prostate cancer: Results of the FOSTINE trial. PLoS One. 2021 Jul 14;16(7):e0252040. doi: 10.1371/journal.pone.0252040. eCollection 2021.
- Chiu PK, Lo KL, Teoh JY, Ma SF, Leung CH, Wong HF, Li KM, Sae-Lo K, Kwok SW, Li SY, Yee CH, Hou SM, Ng CF. Sectoral cancer detection and tolerability of freehand transperineal prostate biopsy under local anaesthesia. Prostate Cancer Prostatic Dis. 2021 Jun;24(2):431-438. doi: 10.1038/s41391-020-00293-1. Epub 2020 Sep 30.
- Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial. Urology. 2021 Jul;153:270-276. doi: 10.1016/j.urology.2020.12.022. Epub 2020 Dec 26.
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- Lo KL, Chui KL, Leung CH, Ma SF, Lim K, Ng T, Wong J, Li JKM, Mak SK, Ng CF. Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy. Hong Kong Med J. 2019 Jun;25(3):209-215. doi: 10.12809/hkmj187599. Epub 2019 May 29.
- Madersbacher S, Lackner J, Brössner C, Röhlich M, Stancik I, Willinger M, Schatzl G; Prostate Study Group of the Austrian Society of Urology. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005 Apr;47(4):499-504. Epub 2005 Jan 23.
- McVary KT, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, Pliskin M, Beahrs JR, Prall D, Kaminetsky J, Cowan BE, Cantrill CH, Mynderse LA, Ulchaker JC, Tadros NN, Gange SN, Roehrborn CG. Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2021 Sep;206(3):715-724. doi: 10.1097/JU.0000000000001778. Epub 2021 Apr 19.
- Ng CF, Yee CH, Chan CK, Wong HM, Chiu PK, Tsu JH, Teoh JY, Ho KL. Bipolar transurethral vapourisation versus monopolar transurethral resection of prostate: a randomised controlled trial. Hong Kong Med J. 2017 Jun;23 Suppl 2(3):32-34.
- Raizenne BL, Zheng X, Mao J, Zorn KC, Cho A, Elterman D, Bhojani N, Sedrakyan A, Chughtai B. Real-world data comparing minimally invasive surgeries for benign prostatic hyperplasia. World J Urol. 2022 May;40(5):1185-1193. doi: 10.1007/s00345-021-03926-9. Epub 2022 Feb 2.
- Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F; CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010 Jan;57(1):123-31. doi: 10.1016/j.eururo.2009.09.035. Epub 2009 Sep 19. Erratum in: Eur Urol. 2010 Nov;58(5):801.
- Yee CH, Wong JH, Chiu PK, Chan CK, Lee WM, Tsu JH, Teoh JY, Ng CF. Short-stay transurethral prostate surgery: A randomized controlled trial comparing transurethral resection in saline bipolar transurethral vaporization of the prostate with monopolar transurethral resection. Asian J Endosc Surg. 2015 Aug;8(3):316-22. doi: 10.1111/ases.12197. Epub 2015 Jun 3.
- Zhang W, Zhang X, Li H, Wu F, Wang H, Zhao M, Hu H, Xu K. Prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in China: results from the China Health and Retirement Longitudinal Study. BMJ Open. 2019 Jun 19;9(6):e022792. doi: 10.1136/bmjopen-2018-022792.
- CRE 2022.249