FOcal RECurrent Assessment and Salvage Treatment (FORECAST)

University College London Hospitals NHS Foundation Trust (UCLH)

Status and phase: Unknown; Phase 2

Conditions: Progression of Prostate Cancer

Treatments: Device: Whole Body MRI; Procedure: MRI Targeted biopsies; Procedure: Focal Salvage Therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT01883128

1R01CA135089

Details and patient eligibility

About

Radiotherapy is the commonest form of prostate cancer treatment in the UK. In one in four men, radiotherapy will fail to control the cancer. These men are offered hormonal treatment which has significant side effects. Few men are offered a further treatment such as surgery, HIFU or cryotherapy. Only half of these men are cancer free at 5 years. The investigators believe this is due to poor imaging tests such as CT and Bone scan that cannot accurately detect whether cancer has come back inside or outside of the prostate or both. Also radiotherapy damages tissue surrounding the prostate which affects tissue healing for example after surgery. Treating just the cancer in the prostate only (focal treatment) rather than the whole prostate may limit this damage and cause fewer side-effects. The investigators want to see if new imaging tests can better identify cancer that has spread outside of the prostate and areas of cancer inside the prostate. Our new tests are whole-body MRI (for distant disease) and MRI guided biopsies (MRI-TB) (for local disease). First, the investigators will compare the results of whole-body MRI to existing imaging tests (bone-scan, and choline PET/CT) that try to find distant spread. Second, the investigators will compare the results of MRI-TB to a very detailed and accurate biopsy of the prostate called template prostate mapping which will show us where and how aggressive the cancer is. Third, if the cancer is confined to the prostate, the investigators will treat men using focal salvage therapies HIFU and cryotherapy. The investigators believe that these new imaging tests could better identify those who will benefit from early hormone treatment and those who will benefit from local salvage treatment. Our study may help justify carrying out a larger trial looking at how good the treatment is in controlling cancer in the medium and long-term.

Enrollment: 177 estimated patients

Sex: Male

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Previous external beam radiotherapy with or without neo-adjuvant/adjuvant hormone therapy
2. Biochemical failure as defined by the Phoenix criteria (PSA nadir + 2ng/ml)
3. Men considering local salvage treatment for radio-recurrent disease
4. Life expectancy of 5 years or more

Exclusion criteria

1. Have taken any form of hormones (except 5-alpha reductase inhibitors) within the previous 6 months
2. Unable to have MRI scan as defined by standard care practice
3. Metallic implant likely to cause artefact and reduce scan quality
4. PSA doubling time of 3 months or less
5. PSA value 20ng/ml or greater
6. Prior prostate biopsies following biochemical failure
7. Any prior local intervention to the prostate (e.g., laser/electrical resection or incision, cryotherapy, HIFU, any other ablative modality, any other radiotherapy, any other prostate injection therapy for symptoms or cancer control)
8. Unable to have general or regional anaesthesia
9. Unable to give informed consent

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: Single Blind

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177 participants in 3 patient groups

Whole body MRI

Experimental group

Description:

Comparing the detection rate of metastases of whole body MRI compared to current standard of care tests - Choline PET and Bone scan.

Treatment:

Device: Whole Body MRI

MRI Targeted Biopsies

Experimental group

Description:

Transperineal MRI-targeted biopsies and whole-gland transperineal prostate mapping biopsies

Treatment:

Procedure: MRI Targeted biopsies

Focal Salvage Therapy

Experimental group

Description:

Focal salvage HIFU and cryotherapy of recurrent prostate cancer tumors only

Treatment:

Procedure: Focal Salvage Therapy