Artificial Intelligence to Personalize Prostate Cancer Treatment (the HypoElect Trial)
Whole-pelvis Hypofractionated Radiotherapy Combined With Dose-escalation to the Prostate and Androgen Deprivation Therapy in Primary Localized, NCCN and MMAI High-risk Prostate Cancer - a Prospective, Single-arm, Phase II Study
German Oncology Center, Cyprus
30 participants
Sep 16, 2024
INTERVENTIONAL
Conditions
Summary
A prospective, single-arm phase II study is the individualization of RT for patients with high-risk localized PCa based on multimodal artificial intelligence (MMAI). All patients will receive the current standard of care: (i) a dose escalation to the prostate via HDR brachytherapy, (ii) two years of ADT and (iii) whole-pelvis UHF-RT (5 fractions).
Eligibility
Inclusion Criteria9
- Histologically confirmed adenocarcinoma of the prostate (histological confirmation can be based on tissue taken at any time, but a re-biopsy should be considered if the biopsy is more than 12 months old)
- Primary PCa (in PSMA-PET imaging and multiparametric magnetic resonance imaging (mpMRI)
- High- or very high-risk according to NCCNv1.2023 criteria
- Signed written informed consent for this study
- Age \>18 years
- Previously conducted PSMA-PET/CT, mpMRI or PSMA-PET/MR
- MMAI high-risk
- ECOG Performance score 0 or 1
- IPSS Score ≤15
Exclusion Criteria20
- Prior radiotherapy to the prostate or pelvis
- Prior radical prostatectomy
- Prior focal therapy approaches to the prostate
- Evidence of pelvic nodal disease (cN+) in mpMRI and/or PSMA-PET/CT
- Evidence of distant metastatic disease (cM+) in mpMRI and/or PSMA-PET/CT
- Time gap between the beginning of any systemic therapyADT and conduction of PSMA-PET scans is \>2 months
- Evidence of cT4 disease in mpMRI and/or PSMA-PET/CT
- PSA \>50 ng/ml prior to starting of systemic therapy
- Expected patient survival \<5 years
- Bilateral hip prostheses or any other implants/hardware that would introduce substantial CT artifacts
- Contraindication to undergo a MRI scan
- Contraindication to undergo HDR brachytherapy (brachytherapy not feasible due to large prostate volume, prostate anatomy, tumor in distant seminal vesicles and/or unfit for anesthesia)
- Prostate surgery (TURP or HOLEP) with a significant tissue cavity or prostate surgery (TURP or HOLEP) within the last 6 months prior to randomization
- Medical conditions likely to make radiotherapy inadvisable e.g. acute inflammatory bowel disease, hemiplegia or paraplegia
- Previous malignancy within the last 2 years (except basal cell carcinoma or squamous cell carcinoma of the skin), or if previous malignancy is expected to significantly compromise 5 year survival
- Any other contraindication to external beam radiotherapy (EBRT) to the pelvis
- Participation in any other interventional clinical trial within the last 30 days before the start of this trial
- Simultaneous participation in other interventional trials which could interfere with this trial; simultaneous participation in registry and diagnostic trials is allowed
- Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial
- Known or persistent abuse of medication, drugs or alcohol
Interventions
The patients under ADT and the patients who will receive the ADT during the study will be included in the trial. * ADT will be applied for 24 months in total * ADT must be given concurrently and adjuvant
HDR BRT Procedure will be performed using transperineal catheter implantation under transrectal US-guidance performed under anesthesia, spinal or general with patient in high lithotomy position.)
EBRT prostate + elective pelvis (Ultra-hypofractionated): 25 Gy in 5 Gy per fraction
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT06582446